Dr. Judy Sigmund’s letter in the August 18 issue struck a cord of sadness. I have been a practicing clinical social worker for more than 30 years. My best years were before managed care, when the psychiatrist and I truly shared clients. A good physician and a skilled clinician bring to the treatment situation the kind of powerful intervention that neither pills nor talk therapy alone can provide a challenging client.

Now I am alone, always explaining to clients why the psychiatrist spends so little time listening to them and why med visits are stretched out over a period of weeks, then months. I have to coach clients to follow script directions and to call the psychiatrist if side effects are problematic. The clients are never truly mine, however, because I was not trained to practice medicine and do not enjoy pinch hitting. Nonetheless, it is almost always me alone chasing the physician if I want to discuss a client. My efforts should be directed at client/family dynamics and problem solving, not at constantly explaining the insurance industry’s "mangled care."

Psychiatrists and social workers bring a variety of diverse and interesting approaches to psychiatric treatment. Collaboration, not competition for time and insurance dollars, should be the rule.

Shelley Bleecker, M.S.W., L.C.I.S.W.

Providence, R.I.