Despite all the forces in the past decade that have conspired against it, psychiatrists must stay focused on what matters most in the delivery of psychiatric care—the doctor-patient relationship.

So said outgoing APA President Allan Tasman, M.D., before an audience of 1,500 at the Opening Session of APA’s 2000 annual meeting in Chicago last month.

"That this core of our work forms the context for all our endeavors is obvious to clinicians and patients," said Tasman. "In recent years, however, restrictive managed care practices and government and industry interference with the privacy of communications with patients and the confidentiality of medical records have intruded on the sanctity of our relationship with patients. Changes in medical and psychiatric education have also understandably focused more curriculum time on technological and scientific advances but at the expense of attention to our role as healers."

APA, he noted, is working hard on a number of fronts to achieve a reimbursement system that returns medical decision making to patients and their physicians. Some of these efforts include the creation of APA’s Division of Clinical Services and the appointment of Lloyd Sederer, M.D., as director; a long-term, multimillion-dollar initiative to educate business and industry leaders about the rightness and cost-effectiveness of psychiatric care; and the continuing development of practice guidelines and quality indicators.

Managed care has also intruded into psychiatric practice by attempting to restrict psychiatrists’ scope of practice, Tasman continued. Such restriction is another way in which patients are effectively denied access to high-quality psychiatric care. He noted that APA’s Committee on Workforce Issues recently conducted a survey of members’ views about what they believe is the appropriate knowledge and skills base for psychiatrists.

At a time when patients are struggling to get the psychiatric care they need, ironically they have never had greater access to the latest information about psychiatric illnesses and effective treatments as they do now through the Internet. More than 30 million people each month seek health information on the Internet, said Tasman, and half of those are seeking information on mental health. The new Web site in which APA is a partner with other major medical specialty societies, Medem.com, will enable APA to communicate directly with the public and patients, he added.

Throughout his presidential year, Tasman has focused attention on the importance of training psychiatry residents in psychotherapeutic modalities—something he believes is essential to the creation of a strong doctor-patient relationship (drugs.html).

"We are in danger of training a generation of psychiatrists who lack even the most basic psychotherapeutic skills or a framework for understanding mental health functioning from a psychological perspective," Tasman warned his audience.

To those who believe that future psychiatric practice will rely primarily on somatic treatments, Tasman pointed out that research demonstrates that "treatment works best when it occurs within the context of a caring and trusting therapeutic relationship, [and] how we use the doctor-patient relationship to address treatment compliance—even when our interventions are primarily somatic or pharmacologic—is of central importance to excellent care."

While residents are being trained to do a thorough diagnostic exam based on DSM-IV, Tasman said that the next edition of the manual should incorporate provisions for "understanding the role of psychological conflict in developmental distress in the emergence of the symptoms we see."

One development with which he said he was pleased is that as of January 2001 the Residency Review Committee in Psychiatry will require residency programs to attest to the competence of graduating residents in several forms of psychotherapy. Moreover, APA will be working with other relevant organizations—for example, those representing psychiatry department chairs and residency training directors—on identifying, teaching, and assessing core competencies in psychiatry.

Findings from recent neuroscientific research leading to new and better psychiatric treatments will not lessen the primacy of the doctor-relationship, Tasman emphasized. "Research has clearly shown that interpersonal experience, such as a therapeutic relationship, can alter brain function in the same way as medications. So if anything, these scientific advances reaffirm my belief that for the foreseeable future, psychotherapeutic skills and the ability to develop and utilize a therapeutic relationship remain essential parts of our treatment armamentarium."

Advances in computer technology also have many implications for the future of psychiatry, said Tasman. While such developments are exciting for the field’s research, education, and clinical missions, he warned that their dark side also needs to be addressed. Psychiatry, "both by virtue of our training and societal sanction, must face the challenge of preserving the ‘human’ within an increasingly mechanistic world."

In his own career, Tasman said, the doctor-patient relationship has been central to the care he has provided. He assured his listeners that he and APA’s Board of Trustees have been committed to helping create a system in which psychiatry will be able to provide the best care to all who need it.

"The future of psychiatry is very bright," concluded Tasman. "I am optimistic and confident that we will continue to play the major role in determining the future direction of our profession."—C.F.B.