Agraphia Medical Tragicomedy

21Aug/06Off

Pill Pushers

We had our Psych visit today. A group of 10 medical students watched a psych resident interview a woman who slit her wrists and popped several Xanax last night. Some thoughts:

• A psychiatric interview is much different from psychotherapy. Psychotherapy is what you always see on TV with the goofy knitted sweaters and the comfy couch. An interview is much more directed and is aimed at pinpointing exactly what psychiatric disorders may be present. It's also much more interesting than what you see on TV.

• In our case, the woman was very cookie cutter. Strong family history of manic/depression with her own episodes of mania and depression. The depression was comorbid with mild anorexia to help regain her sense of self control. There was an episode of sexual abuse in her past to which she attributed a lot of her anxiety and depression. Pretty cut-and-dried, which is nice. I thought shrinks usually dealt in grey, murky areas.

• Nobody should ever walk into a patient room in the middle of an interview, especially when the patient has just admitted that she was abused. It really screws with the flow. Jeez.

I think what struck me the most, though, was the fact that she started going to counseling last week, because she was worried she would try to hurt herself. Which she then did. Unfortunately, the psychiatrist only saw her for 15 minutes, put her on a couple of pills (that she then OD'ed on) and shoved her out of his office. He didn't even bother to schedule a followup.

The medical students were all up in arms about this terrible psychiatrist. But, what the resident then said really struck me. Managed care is hitting all areas of medicine, even psychiatry. It's hard to do proper psychotherapy when HMOs only pay for 15 minutes worth of counseling time. The sessions go something like this...

Doc: "How are you doing?"
Patient: "I'm a little depressed."
Doc: "Fine, then, we'll up your dose."

It's hard to do anything more than simple pill pushing when you can't spend the time to really talk to your patients.

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