Healthy Tips For Better Life

The Psychiatrist Specialist in Health Reform

Physician specialists are often seen as the culprits in the economics of health care. Numerous articles have appeared in the media about the benefits of obtaining non-physician medical care. Many ponder whether decades of specialized training can be compacted into a one year training course. So what may be the benefits my patients receive by seeing a psychiatrist? Insurance payers have created the myth that psychiatrists are trained only in the use of medications. It may surprise many that during three years of residency psychiatrists receive training and supervision in a variety of types of psychotherapy. My long term supervisor during my residency was the former president of the American Psychoanalytic Society. As a trained psychiatrist, can I be easily replicated by a non specialist with limited training? How should I advise my patients concerning new provider selection necessitated by changes in their insurance reimbursement?

As a first step, it is important for a patient to understand their diagnosis and how it can limit their daily life. The media and herbal industry advertise interventions that supposedly can help depression including herbs, massage, and integrative alternatives. Unfortunately, advertisements do not distinguish between mild and severe depression. Alternative treatment may be helpful for mild depression which is generally responsive to distraction. By definition, mild depression symptoms are few and do not impede personal function. For example, you wake up feeling depressed and blue, you acknowledge it and call a friend, or go to work and the feeling disappears. With severe depression, symptoms such as an inability to get out of bed due to a debilitating loss of energy, a loss of appetite, a challenge with focus or concentration, and continuous intrusive thoughts about suicide are often present. The differences in intensity of symptoms and their impact on daily function are obvious. Nonetheless, the daily message is that depression can be treated with any new intervention regardless of a lack of scientific basis or determination of severity of illness.

The article "Pregnant Pause" featured in Vogue Magazine (May, 2009) was a poignant description of the daily challenges faced by those in the subspecialty of reproductive psychiatry. The article described a pregnant female with eating phobias and bizarre obsessive thoughts which impeded her daily functioning. Yet she was cited as having mild depression and was treated by her primary care physician. The article highlighted the adverse outcomes of antidepressant treatment during pregnancy. It emphasized the patient's mild illness and that she received erroneous information. However, patients with severe illness often receive their mental health care from those with limited psychiatric training as the stigma of psychiatry is rampant.

Reputable magazines often do not address severity of illness and introduce potential interventions that are without scientific merit. As a psychiatrist with an expertise in reproductive health, I discuss risks versus benefits when counseling patients about treatment options. My award winning book, The Pregnancy Decision Handbook for Women with Depression, was written as an informational resource to be used in the development of individualized treatment plans. Women have various treatment options that are based upon the severity of their illness.

My patients' inquiries about other potential mental health providers are answered by my suggestion to have an honest consideration of their illness. If you have a severe illness that impedes your functioning, challenging prior medication trials, a current medication that is not the usual low dose of an SSRI, you should retain the guidance of a psychiatrist. Prozac and the introduction of the serotonin selective inhibitors (SSRIs) was a great advance in mental health treatment. Nonetheless, if you have had twenty years of suffering with depression, stabilization of symptoms will require experience dealing with treatments that are not usually comfortable for health providers with less training.

In my opinion, individuals with strong family histories of mental illness and prior bouts of illness that caused severe disability should be seen by a specialist for at least a consultation. Many patients are referred to psychiatrists after repeated medication failures by those with limited experience. Treatment resistance is often a result of misdiagnosis or inappropriate medication dosages from less trained health professionals. In addition, my extensive training and experience allow me to identify which emotions are related to an underlying medical condition and which are related to a psychiatric condition. Many times no medication is rendered since it seems to be a life situation that triggers feeling bad without impeding function. The patient really needs better coping skills to deal with their stressful event instead of a prescription written after a ten minute crisis assessment. The current health care debate questions my presence as costly, but is seeing a psychiatrist really wasteful? Is it wasteful if the psychiatrist can correctly diagnose and treat the illness? Can a primary care physician and counselor replace a well trained, reputable psychiatrist?