A recent article in the New York Times entitled “Talk doesn’t pay, so psychiatry turns instead to drug therapy” has created quite a stir among my psychiatric colleagues, rightly so in my opinion.
Limited practice, limited help
The Times reporter features a Pennsylvania psychiatrist, Donald Levin, MD, who contends that in order to sustain his income, he has been forced to limit his practice to 15-minute sessions in which he only prescribes and adjusts medications. Dr. Levin is quoted saying he had to train himself “not to get too interested” in his patients’ problems and that he now feels “like a good Volkswagen mechanic.” What a sad state of affairs, but one all too common in much of medicine today – just review the daily schedule of your primary care physician, and you’ll see the same breakneck pace of daily practice.
A comprehensive approach
Psychiatrists are physicians, and psychiatric disorders are complex medical illnesses. But psychiatrists are taught to try and understand the full scope of human behavior – not just the illness, but also the person who has the illness. Many patients need medication, and psychopharmacological knowledge and experience are crucial components of psychiatric treatment.
Evidence has taught us, however, that psychotherapy is not just random “talk therapy,” but, rather, an effective treatment for many psychiatric disorders, and a biological treatment at that, which can change the brain. Psychiatrists are taught to look through a biopsychosocial lens to understand and treat patients, and to monitor the effectiveness of that treatment. The day I disregard the psychosocial part of the picture, or, to put it in the words of Dr. Levin, choose “not to get too interested” in my patients, is the day I should take down my shingle.
Editor’s note: Dr. Oldham is president-elect of the American Psychiatric Association. He is also the chief of staff and senior vice president of The Menninger Clinic and executive vice chair of the Menninger Department of Psychiatry & Behavioral Sciences at Baylor College of Medicine.