Commentary: They Changed the Game

They changed the game on me, and I am quite angry about it.

People often ask me why a board-certified psychiatrist with specialty training in child and adolescent psychiatry has chosen not to practice. I have decided to shed light on this subject because I have finally acknowledged the answer.

I have just finished reading another recruitment letter, looking for a psychiatrist to provide medication management and evaluations for a mental health care group in Anywhere, U.S.A. In this day of managed mental health care, the role of the psychiatrist is to diagnose mental disorders and to prescribe medications. When patients become "stable," the psychiatrist sees them at approximately three-month intervals for 15-minute medication checks.

My job is to pronounce the name of the disorder and to write the prescriptions to fix it. I receive financial incentives to evaluate and medicate as many patients as possible. If psychotherapy is called for, then I must refer my patient to a psychotherapist. Never mind that I have received excellent training in psychotherapy. Never mind that my particular gift is in bringing a person to wholeness through the realm of the spoken word.

Yes, I am angry because I am being used just for my knowledge of drug metabolism and the interactions of drugs on enzyme systems. No one asks me to expound on my understanding of how childhood pain can result in untold suffering in the adult world.

They changed the game on me, and I don't know when it happened. When did the science of medicine supersede the art? When did therapy in the bottle replace the healing balm of one-to-one interaction? I believe in the team approach to healing, yet I have discovered that my role on the treatment team is: "Just diagnose this patient, Doctor, and recommend treatment. We'll take it from there."

My heart still grieves for those who society struggles to understand. I still look with compassion on those who suffer from the ravages of mental illness, yet I find that I must strive to ease their suffering in another way. I have not abandoned the principles of good psychiatric practice, but I've chosen to pursue my passion for helping people who are hurting via other avenues.

When productivity is measured in terms of the people's lives that are changed, and not just by the numbers of patients who are seen, I may return to the practice of psychiatry. Maybe one day society will again embrace those of us who value the power of the spoken word and the healing touch of the physician. In this era of managed care, the game has certainly changed, and I just don't know the rules.