UNITING PHYSICIANS & PATIENTS AS A VOICE IN HEALTH CARE
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Q: What can we do to encourage more medical students to consider psychiatry as a career choice?
A: Support the able efforts of the University of Minnesota Department of Psychiatry, Mayo Clinic, and create clinical teaching mentorships for students and residents with practicing community psychiatrists. The Minnesota Psychiatric Society has a strong and nurturing Women's Psychiatry Committee, for example.
Q: What can we do to help reestablish behavioral health as an essential component of good, overall patient care, especially for patients with chronic or complex medical needs?
A: Actually, I do not like the term "behavioral health" because it overlooks the presence of motivation, emotion, and cognition in almost all aspects of medical care. Also, psychiatrists are physicians and often detect problems which require the attention of other physicians. We know what to do to practice good psychiatric medicine. This includes the valuable contributions of psychologists and others. Are doctors willing to step up to the plate and help their patients get quality psychiatric services? I think so.
Q: You have long been a pillar of quality psychiatric care. For over 30 years you have maintained an independent practice which among many specialties has become rare. How do you see the future for psychiatry, family medicine, and other primary care specialties?
A: I hope to contribute to these discussions in the future. We, as professionals, are valuable to our patients. Just ask them.
Q: You have a long and distinguished history of critiquing insurance companies and mental health carveouts. Do you feel that a single-payor (public) system would obviate all carveouts, and what are the advantages/disadvantages to the mental health consumer/provider of such a system?
A: No, I do not see a single payor as a panacea at all. We do in fact have single payor for most severely mentally ill patients now -- Medicare and medical assistance. I favor allowing patients more control of where these dollars go in our public and private systems, am very concerned that we as a society have shirked our responsibility to this vulnerable population, and I strongly urge professional and public advocacy for mentally ill patients -- to include their housing in the community.
Q: What might you see as appropriate responses/plans from organized medicine to address what I see in my practice of emergency medicine as a crisis in the provision of psychiatric services for both inpatients and outpatients? Not only finding beds for those with unstable psychiatric emergencies, but also arranging care for those who need outpatient evaluation and care has become harder and harder over the years. Yet, patients and/or their families expect that these services will be available (and reasonably so) and often they're not, at least in a timely fashion. How desperate does it have to get before it gets better?
A: Emergency medicine physicians are faced with daunting challenges concerning the evaluation and disposition of mentally ill and substance using patients. ER docs are doing the right thing by insisting on more support in the ER for psychiatric evaluation services under your control. Certainly mental health nurses are a part of the solution. ER doctors and their staff want access to psychiatrists. You are successfully approaching hospital administrators and government payors about the ER and short term psychiatric bed crisis in the Twin Cities and in greater Minnesota. The MMA and Minnesota Psychiatric Society strongly support these efforts. We clearly need to encourage more psychiatrists to take on new patients and negotiate collaborations, for example, with mental health centers and hospital triage.
Q: How should practicing physicians respond when health plan or disease management sponsored case or disease managers (with informed consent; psychiatry or otherwise) contact them about helping to facilitate improved clinical outcomes for one of their patients?
A: Collaboratively and also with skepticism. The patient should first be informed of insurance case management activities and give his consent. Patient inquiries about cost and accountability to all parties, including the insurance company, are always appropriate. The doctor, clinic, or mental health center is the real venue of care rather than a health plan or insurance company.
In this interview I seek to:
Lee Beecher's Website is an example of such a free doctor website available now through medscape/WebMd.
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