My `800' Toll-Free Telephone Line

By Harold I. Eist, M.D.
APA President

I have heard from literally thousands of you over the past two years. My travel, meeting, media, testifying, and practice schedule has prevented me from being available on many of my "800" number days. However, when I return, I find that you have been calling. The voicemail on my "800" line is full, and the machines on my other lines are also full. On my two most recent "800" days, I took 24 calls (when I am sitting by the phone, I can take about 12 calls per hour). Twenty were encouraging, supportive, and congratulatory.

Between my various lines, I have averaged more than 40 calls a week. A crude estimate is that I have received, over two years, between 4,000 and 5,000 calls. I have spoken with approximately 2,300 of you, some of you several times.

I deeply appreciate your taking the time to call me. Your generous calls constitute an ongoing performance evaluation and, as such, are invaluable. They energize me and help me maintain my focus in these difficult times. I try to return the calls I don't directly field, but, unfortunately, I am many hundreds of calls behind. I respond to the urgent calls as quickly as I can or have somebody from the APA staff contact you. Regrettably, however, I have not gotten to each and every person who has tried to reach me. A New Jersey chapter president asked, in the New Jersey Newsletter, if anyone had gotten through to me, because she hadn't, although she had tried several times. I have tried to contact her, but we have not yet spoken to each other. I will keep trying and would encourage her to do so also.

I will continue returning calls, even after my term expires at the end of the annual meeting in May, until I have made contact with as many of you as I can reach. Large numbers of you have informed me, when I have visited your district branch (I have visited 52) or academic department (I have spoken at between 25 and 30), that you were not able to get through. Either the voicemail was full or my phone line was down. If you try again, if we keep working at it, we can get to talk. It is clear that numerous attempts have been made to reach me and were not recorded and that, in terms of your interest and responsiveness, the "800" line has been accepted as an important membership communication vehicle.

While many calls require some APA action, a significant number of you have called just to leave a message and have specifically indicated that you do not require a return call. These informational calls have been valuable also, because they keep me aware of your thoughts about key issues.

Your calls have clustered in a number of areas. Far and away, the largest number of calls referred to the excesses of managed care, its destructiveness to patients and your practices, and your abiding concerns about your patients and the doctor/patient relationship. You called to inform me of impediments to care; threats to continuity of care; traumatic dissolution of valued doctor/patient involvement because of not meeting financially determined criteria of what was enough service; discharges from panels without cause or because of advocating for patients; veiled threats because you fell outside of psychotherapy profiles set as financially optimal for corporations without concern for what was clinically optimal for patients; controlled formularies, which interfered with your prerogatives and responsibilities to prescribe optimally for your patients; and endless demoralizing, rude, and cold, if not heartless, assaults on your professional dignity and the dignity of your patients and their confidentiality rights.

Your thousands of calls, from every part of the country, put the lie to the oft-repeated managed care statement that only a vocal minority of doctors are against managed care policies and what they do. How could any reasonable person believe this? Actually, the managed care people have twisted the facts. Only a vocal minority of physicians are pro-managed care, and the ranks of these vocal exponents are diminishing and almost exclusively limited to management, backed up by large public relations firms.

I hear, too, from many families and victims of managed care. Their stories, frustrations, and worries are most distressing and painful. Suicidal patients and their loved ones have called me, pleading for me to help them get the help they need, but which has been denied. Parents have turned to me in desperation to aid them in getting medication for a child suffering from psychosis. These tormented pleas have often not been brought to me with any conviction that I would act constructively on behalf of the petitioner; they were mere last-ditch attempts to wring assistance from a system that has failed the people, a system of which they were deeply suspicious. It has been terribly painful for these patients and their families to make one last appeal to a greed-driven system, forgetful of humanism, altruism, and basic decency. All too many of these patients suspect that psychiatrists are a part of this system, that APA and organized medicine are part of this system, and they suspected me of dispensing false hope. I think most of the patient callers and their families learned that we were and are dedicated to helping them.

Nevertheless, I could not help but feel shame that those who were suffering so profoundly experienced American psychiatry and the house of medicine as undependable and ineffectual. This has further hardened my resolve (and should harden every physician's resolve) to protect our patients' care and come to their aid. We will not--we dare not--abandon those we are pledged to serve.

I am appalled when managed care executives diminish or demean the suffering they cause to patients by referring to it as "anecdotal," improperly suggesting that even if, in fact, these cases were rare (which they are not), this suffering is not significant. Physicians and insurance commissioners are hearing tens of thousands or more of these so-called "just anecdotal" complaints, and the press is beginning to report them. State insurance commissioners have referred thousands of ERISA-violation claims to the federal government.

Another major topic of concern, one that initially surprised me, were calls from psychiatrists wanting to get involved in disaster work. These calls came in both before and after APA concluded an agreement with the Red Cross during Dr. Mary Jane England's presidency to provide the mental health component of disaster work. I would strongly encourage each district branch to organize a disaster committee. The committee should meet with fire departments, police departments, school officials, PTA's, hospitals, ER staffs, churches, service clubs, religious groups, small and large businesses, and all other entities they think important, including the airlines and railways, so that when and if disaster strikes, we will be up and running and ready. Further, through our disaster committees, we can make important strategic alliances in our communities. Those of you seriously interested in disaster relief should contact your local Red Cross to obtain disaster training.

Another large group of calls has come from residents and medical students, expressing their worry that psychotherapy training is inadequate in some of their programs. They recognize that they cannot be multi-dimensional psychiatrists and effective psychiatric clinicians without this training. Our young people, and those medical students seriously considering entering our ranks, appreciate the centrality of psychotherapy in our professional identity. One medical student told me he was not going into psychiatry unless he was given assurances that he would get comprehensive psychotherapy training.

There were also frequent calls about dues, most of them, interestingly, coming from retired and/or life members or fellows. Nearly all the comments about dues related to changes in policy that suddenly required retirees and life fellows to pay dues when retirees and life fellows of a former time had their dues waived. Though our officers have gotten a wide range of views from you on dues, the general consensus of those who have spoken with me is, "We want value for dues. If we get that, we are willing, if not pleased, to pay them."

You can see that the calls reflect the concerns that have become the focus of our organizational initiatives. You have clearly demonstrated that we need to hear from you in formulating our initiatives and that as long as we formulate them in concert with your concerns, we cannot and will not go wrong.

(Psychiatric News, April 4, 1997)