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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by jane d on March 9, 2011, at 0:08:58
http://www.nytimes.com/2011/03/06/health/policy/06doctors.html?ref=health&src=me&pagewanted=all
Also the comments at: http://well.blogs.nytimes.com/2011/03/06/less-talk-more-medicine/
There was an interesting, and fairly critical, profile in last Sunday's NY Times of a psychiatrist describing why he switched from doing talk therapy to just doing 15 minute med checks.
My own problem with this is not that he is using medication instead of talk therapy although that is the focus of a lot of the critical comments. I believe that the right medication at the right time can be a wonderful thing. But I can't see how he can actually do a decent job providing that in the limited time he is spending with his patients.
I found this article horrifying. The psychiatrist I saw didn't do this but he certainly sounds like many that have been described here. Is this really what most of them are like today? If so, why would anyone pay for this?
Posted by mtdewcmu on March 9, 2011, at 2:24:46
In reply to NYT Article - Psychiatrist's rationalization$$, posted by jane d on March 9, 2011, at 0:08:58
Yes, most psychiatrists today don't do talk therapy. The reason that people pay for them is that they're the ones that can prescribe meds, unlike social workers and psychologists.
I don't understand why someone would need to go to medical school in order to do talk therapy. Back when Freudian psychoanalysis was still popular, there was actually a lot to learn in order to do talk therapy. So you could make more of a case that a therapist needed to be highly educated. But, most of what is learned in medical school is irrelevant to talk therapy, and, given the exorbitantly high cost of medical school, it's hard to imagine psychiatrists being able to do talk therapy for a reasonable price.
> http://www.nytimes.com/2011/03/06/health/policy/06doctors.html?ref=health&src=me&pagewanted=all
>
> Also the comments at: http://well.blogs.nytimes.com/2011/03/06/less-talk-more-medicine/
>
> There was an interesting, and fairly critical, profile in last Sunday's NY Times of a psychiatrist describing why he switched from doing talk therapy to just doing 15 minute med checks.
>
> My own problem with this is not that he is using medication instead of talk therapy although that is the focus of a lot of the critical comments. I believe that the right medication at the right time can be a wonderful thing. But I can't see how he can actually do a decent job providing that in the limited time he is spending with his patients.
>
> I found this article horrifying. The psychiatrist I saw didn't do this but he certainly sounds like many that have been described here. Is this really what most of them are like today? If so, why would anyone pay for this?
>
Posted by Dinah on March 9, 2011, at 11:41:39
In reply to NYT Article - Psychiatrist's rationalization$$, posted by jane d on March 9, 2011, at 0:08:58
I agree with you. I don't mind that psychiatrists no longer do talk therapy. I would think training of various professionals today wouldn't make psychiatrists any better candidates, depending on the doctor of course, than any other mental health professional. In fact, in my area, psychologists are in such short supply that many seem more willing to do psychological testing than therapy.
What I do mind is that he's admitting to churning patients in and out on a basis that make it highly improbable, in my opinion, that he is able to give proper medication management. He admits that he was all ready to treat one patient for anxiety before the patient admitted in the last five minutes to being suicidal. Many patients seeing a psychiatrist for the first time may not be so complete in their descriptions that a doctor should feel comfortable prescribing a pill and sending them on their way for a month or so.
I am sad to say that I don't *only* see this among psychiatrists. I have very few doctors that I would mind losing. Maybe two that I think are providing me excellent care along with at least an appearance of empathy. The best of the lot was my migraine doctor, who took a very very thorough history of all my medical concerns and did a thorough physical exam. At least my current psychiatrist, although uninterested in what is going on in my life, is very concerned with side effects, other medical conditions, and receiving results of my lab work. Given the numerous side effects of psych meds, I can't see anything less than this as being adequate care.
I think this article is an indictment of many of the medical profession, not just psychiatrists.
And for the record, I'd consider that article grounds to fire any psychiatrist of mine who made comments like that. I wonder how many of his numerous patients will do that.
And I of course recognize (with thankfulness) that this doctor does not represent all psychiatrists or all doctors. Patients need to be careful about firing doctors who aren't what they should be and finding ones that are. I probably should be better at that myself. As it is, I probably only make a push to leave those doctors who seem to push something harmful rather than those who seem less than competent or less than helpful.
Posted by Dinah on March 9, 2011, at 11:55:35
In reply to NYT Article - Psychiatrist's rationalization$$, posted by jane d on March 9, 2011, at 0:08:58
I wonder if there will come a day when all this will be done by computer. I don't see that much difference between that and what this doctor describes.
Doctors should be better than this.
Posted by Peter S on March 9, 2011, at 12:51:52
In reply to NYT Article - Psychiatrist's rationalization$$, posted by jane d on March 9, 2011, at 0:08:58
My concern is not that psychiatrists no longer practice therapy, but what they practice is not really "medical science" in the sense that no one really knows how these medications work (or why they work for some but not others). Treating depression involves a crap shoot of trying a limited number of types of meds and combinations.
It seems like you really need very little training to practice psychopharmacolgy: "Here's an SSRI- oh that doesn't work- let's up the dose- let's try another- oh that one has bad side effects- let's try another- that one is pooping out- maybe let's add an atypical antipsyhotic like Abilify- oh that doesn't work- maybe a tricyclic? That doesn't work- let's go to an MAOI."
Basically there are only 3 classes of meds with some evidence that they treat depression. When you run out of these options- that's it. I don't blame psychiatrists- but it must be very frustrating to be dealing with such a limited hand.
> http://www.nytimes.com/2011/03/06/health/policy/06doctors.html?ref=health&src=me&pagewanted=all
>
> Also the comments at: http://well.blogs.nytimes.com/2011/03/06/less-talk-more-medicine/
>
> There was an interesting, and fairly critical, profile in last Sunday's NY Times of a psychiatrist describing why he switched from doing talk therapy to just doing 15 minute med checks.
>
> My own problem with this is not that he is using medication instead of talk therapy although that is the focus of a lot of the critical comments. I believe that the right medication at the right time can be a wonderful thing. But I can't see how he can actually do a decent job providing that in the limited time he is spending with his patients.
>
> I found this article horrifying. The psychiatrist I saw didn't do this but he certainly sounds like many that have been described here. Is this really what most of them are like today? If so, why would anyone pay for this?
>
Posted by Phillipa on March 9, 2011, at 13:28:16
In reply to Re: NYT Article - Psychiatrist's rationalization$$, posted by Peter S on March 9, 2011, at 12:51:52
Hence I feel that is why I find myself and others say the same trying different doses of meds and combos to no avail. I've yeat since 85 to find a decent pdoc and the one in 85 had me med free and happy. Phillipa
Posted by emmanuel98 on March 9, 2011, at 19:52:16
In reply to Re: NYT Article - Psychiatrist's rationalization$$, posted by Phillipa on March 9, 2011, at 13:28:16
I saw my psychiatrist for five years for weekly therapy. He was great and had been trained in dynamic therapy back in the late 60s and early 70s when most therapy was done by psychiatrists. He told me he studied psychology as an undergraduate and was planning on doing a PsyD, but was so disgusted by the controversies in psychology at the time (Skinner and all) that he went to med school instead.
Unlike the doctor in the NYT article, he sees med patients every two months for half-an-hour (not 15 minutes). He insisted I see a DBT therapist before I stopped therapy with him and they talk at least once a month.
But the interesting is that the insurance company pays my DBT therapist (an LICSW with loads of experience) $65 an hour and allows my psychiatrist $115 an hour for therapy. Of course this is nothing compared to what he could make by seeing four patients an hour for meds. But he doesn't work that way and has a lot of long term therapy patients including a lot of schizophrenics whom he sees for supportive therapy.
I know he is a rarity these days and I'm glad to have found him.
Posted by Phillipa on March 9, 2011, at 22:00:07
In reply to Re: NYT Article - Psychiatrist's rationalization$$, posted by emmanuel98 on March 9, 2011, at 19:52:16
Very lucky indeed. I guess the reason the one have not sees for a 45 minute session is the ride is 4.5 hours each way. She's so old she is forgetting from one visit to next what she said the time before. Not good. Phillipa
Posted by glydin2011 on March 10, 2011, at 0:29:46
In reply to Re: NYT Article - Psychiatrist's rationalization$$ » emmanuel98, posted by Phillipa on March 9, 2011, at 22:00:07
I have had 2 good pdocs (retirement of first) & 1 good CBT Therapist. My meds are now refilled via PCP with a contingency plan in place, with pdoc, for any slippage .... Thankfully, not necessary to date. PCP's handing scripts are a boo hiss to some but works well and is a good plan for me.
Not all MHC providers are rat bait.
Posted by Dinah on March 10, 2011, at 10:24:34
In reply to Re: NYT Article - Psychiatrist's rationalization$$, posted by glydin2011 on March 10, 2011, at 0:29:46
Maybe part of what we learn from this article ought to be that we should demand better from our doctors.
I know I should. I once had a primary care doctor who misdiagnosed a very classic case of kidney stones as diverticulitis and sent me to a GI specialist instead of a urologist. The GI specialist listened to my symptoms and immediately diagnosed me correctly. One thing I described should have instantly pointed her in the right direction. She also wanted to prescribe as a first line treatment opioids for migraines. Yet I continued to go to her until she left town.
I put up with a lot from my doctors and always feel slightly guilty when I look to change them.
One of the comments to that article was that someone had googled this doctor and saw that he got a lot of low marks on the doctor rating sites, with a lot of the same sort of comments that you might guess from the article. So maybe not all his 1200 patients are as happy as he might prefer to think.
Posted by Phillipa on March 10, 2011, at 19:45:57
In reply to Re: NYT Article - Psychiatrist's rationalization$$, posted by Dinah on March 10, 2011, at 10:24:34
I've definitely noticed a bias with medicaire. One doc supposed to be my internist. Was so nice then saw had medicaire and whole attitude changed right then and there. Phillipa
Posted by bleauberry on March 13, 2011, at 8:18:05
In reply to NYT Article - Psychiatrist's rationalization$$, posted by jane d on March 9, 2011, at 0:08:58
>
> I found this article horrifying. The psychiatrist I saw didn't do this but he certainly sounds like many that have been described here. Is this really what most of them are like today? If so, why would anyone pay for this?
>Good question. I don't know. I do not pay them anymore.
I made a monumental challenging decision 3 years ago to not pay them anymore. History. It's been rough going since then, but.....not as rough as when I was under their care. In other words, my improvement did not begin until I cut the addiction of psychiatrists from my life. They were in fact prolonging my suffering rather than shortening it.
A humble creative Nurse Practitioner has been working with me ever since then and has done a far better job. She happens to also be licensed in psychiatry and she likes naturopathy in addition to meds. Her fee is only $90 for an entire hour, versus a psychiatrist who is $200 for 15 minutes. She blows them away in every measure.
As I learned in the book "Amalgam Illness" a well rounded open minded clinician of any type who will cooperate with you along your difficult journey stands a good chance of being a better ally for you than a specialist.
Bottom line. If the current doctor is not moving you forward, find another one. It isn't easy, and it is almost traumatic, kind of scary, but all successful journeys start out that way. Breaking out of your own comfort zone is very hard to do, but sometimes the very best thing to do.
If a psychiatrist was an expert on foods, diets, allergies, inflammation, bacteria, fungi, viruses, and heavy metals...the most common culprits hiding behind the psychiatric symptoms, then I would feel differently.
Posted by sukarno on March 23, 2011, at 10:08:19
In reply to Re: NYT Article - Psychiatrist's rationalization$$, posted by Dinah on March 10, 2011, at 10:24:34
What I've noticed over the years is that you really get what you pay for when it comes to seeing a psychiatrist. I noticed that the more I had to pay, the more willing the psychiatrist was to talk and also more liberal with prescriptions such as controlled substances.
When I went to the free clinics or places that were involved with HMOs the care was not good, in my opinion and experience. They would flat out state to me that they would not prescribe a certain class of medications no matter what (even with my medical history and prescription bottle in front of them) and were not friendly to me in the least. In fact, I felt them to be hostile.
Thus, I have to fork out a lot of cash to get good results from a psychiatrist. Is it worth it for me to pay such high fees? I suppose if only BZDs truly work for my anxiety and only the expensive shrinks will prescribe them, then I have no choice but to see them. I don't think they are "pill mills", but I have met those types (they charge a lot, talk to you for 10 minutes and it is "see you next month").
Posted by mtdewcmu on March 23, 2011, at 13:15:31
In reply to Re: NYT Article - Psychiatrist's rationalization$$, posted by sukarno on March 23, 2011, at 10:08:19
If your definition of a good doc is one that will maintain you on Xanax, you probably don't absolutely need to see a psychiatrist. I think most GPs would be persuaded to maintain your Xanax prescription, if for no other reason than stopping it could be dangerous. I think a lot of psychiatrists are prone to overstate the dangers of benzos, but regular doctors see them as fairly safe drugs.
> What I've noticed over the years is that you really get what you pay for when it comes to seeing a psychiatrist. I noticed that the more I had to pay, the more willing the psychiatrist was to talk and also more liberal with prescriptions such as controlled substances.
>
> When I went to the free clinics or places that were involved with HMOs the care was not good, in my opinion and experience. They would flat out state to me that they would not prescribe a certain class of medications no matter what (even with my medical history and prescription bottle in front of them) and were not friendly to me in the least. In fact, I felt them to be hostile.
>
> Thus, I have to fork out a lot of cash to get good results from a psychiatrist. Is it worth it for me to pay such high fees? I suppose if only BZDs truly work for my anxiety and only the expensive shrinks will prescribe them, then I have no choice but to see them. I don't think they are "pill mills", but I have met those types (they charge a lot, talk to you for 10 minutes and it is "see you next month").
>
>
Posted by linkadge on March 23, 2011, at 16:21:15
In reply to Re: NYT Article - Psychiatrist's rationalization$$, posted by mtdewcmu on March 23, 2011, at 13:15:31
>I think a lot of psychiatrists are prone to >overstate the dangers of benzos, but regular >doctors see them as fairly safe drugs.
Yeah, they'd rather get you hooked on paxil. Although, in some circles, psychiatrists recognize and embrace the notion that SSRIs can be as addictive (and prone to loose effect) as benzos.
Linkadge
Posted by ed_uk2010 on March 27, 2011, at 7:07:30
In reply to NYT Article - Psychiatrist's rationalization$$, posted by jane d on March 9, 2011, at 0:08:58
>But I can't see how he can actually do a decent job providing that in the limited time he is spending with his patients.
>
> I found this article horrifying. The psychiatrist I saw didn't do this but he certainly sounds like many that have been described here. Is this really what most of them are like today? If so, why would anyone pay for this?Might as well see a GP who has an interest in mental health.
This is the end of the thread.
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