Wednesday, April 27, 2011

Hate A Shrink: They Ask For It, After All



Okay, KevinMD today was the final straw. I am so sick Shrink-bashing. We're insensitive, drug-pushers who don't talk to our patients, don't listen to our patients, don't care about our patients. We're in it for the quick buck and "Tell-me-about-your-mother" has been replaced by "Here's your script, NEXT!"

First there was the NY Times article about how shrinks now see 40 patients a day, and the story was about a shrink who tells his patients it's inappropriate for them to tell him their problems. Oy. Shrink Rap commentary HERE.

Next there's MovieDoc who calls shrinks of my ilk who see patients for meds and therapy "sporkiatrists." Jacks of all trades, masters of none, as if one person can't possibly do two things well. You know, I walk and chew gum at the very same time (oy, I'm snarky today).

Oh, and there's the commenter on our Psychology Today blog, Shrink Rap Today, who writes:

'Shrink''Antipsychotics' ('neuroleptics') have been proven to SHRINK the human brain... the frontal cortex, for instance... by about 1 percent loss of brain matter per year... There is horrific fallout from these drugs -So, 'SHRINK' is certainly appropriate.'Rap'Psychiatry, along with its partner in crime, Pharma has a RAP sheet a mile long, particulary in the areas of clinical research, done by psychiatrists... the "off-label" marketing of psychiatric drugs to children, Medicaid fraud... the 'RAP' sheet is quite long.

Thanks for stopping by. Do come again.

And so now KevinMD has a post by a psychiatrist, no less, who writes about how to get heard by your psychiatrist and suggests doing homework and bringing notebooks to those 15 minute med checks. Good we have pointers here because of course we'd assume that no psychiatrist would listen. Dr. Raina writes:

  • Many psychiatrists diagnose a patient’s illness after a 45-50 minute interview, without doing any tests to rule out potential medical causes of psychiatric symptoms and without obtaining history from corroborating sources, as recommended by diagnostic experts.
  • They see patients in follow up for 15 minutes or less.
  • In those 15 minutes all they care about is that the patient says he is better. Once again, they don’t use rating scales or obtain corroborating history to confirm the degree of improvement.
  • In general, patients who take still unfortunately difficult step of seeing a psychiatrist want to believe that they are getting better even when they are not.
  • For a patient, telling a psychiatrist they are not feeling heard might feel too risky – the psychiatrist might get upset at them and might not like them as a patient any more.
  • You could just change psychiatrists. But it’s not easy. You have to reveal the workings of your mind to yet another stranger.
Please, give me a break. What is it with this 15 minute visit stuff? We polled the shrinks in our state. A few see a lot of patients. The most common answer for how many patients do you see on your busiest day of the week? 8-11. Very few see more than 20 patients a day (and these may be 12 hour days?). Many see 1-2 patients/hour. Yes, it's very hard to find a psychiatrist to see you for weekly psychotherapy in-network---insurance just doesn't want to pay for this service. But there is the out-of-network option. On some insurances, it pays 80%. On others, it pays for your parking for the hour.

But we're not all callous jerks waiting to ream patients out if they say they don't feel heard. And what's this bit about how patients want to believe they are better --presumably they are too stupid to know?-- and that's all the doc wants to hear? From a psychiatrist, no less! Dr. Raina, I know a wonderful psychiatrist in Chicago you might like to meet, and I'm sure he'd love to listen to you.

So Clink works in corrections, she sees a lot of patients/inmates, as many as 3 an hour. And her focus is on med management, as is the case in most clinics and institutional settings. Do we think she's callous and uncaring? Ah, I know Clink--she's not. She's brilliant and mild-mannered and while we disagree about some things (about which I'm right), she has principals and she's a devoted and caring advocate for her patients.

I'm tired of being dissed. Thank you for listening.