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By Craig W. Maumus, M.D.
As we begin another year, it is a time to look back and reflect upon the changes of the past year and how we responded to them. Two of our district branch newsletter editors recently wrote thoughtful and perceptive articles about the changes we are going through in our profession and practices.
In her fall 1997 column, Kimberly Merenkov, M.D., editor of the Illinois Psychiatric Society’s Mind Matters, suggests that we embrace change and search for a balance in our lives.
"Change, in general, is a difficult concept that can both exhilarate us and threaten our security," she notes. "It pushes us out of our world of comfort, passivity, familiarity, or suffering. It can be embraced for the promise of new opportunity or intensely avoided for the threat to what is already treasured. It can come as quickly as the sudden death of a popular young princess, which jolts us into a new reckoning about the preciousness of life. Or, it can slowly, step by step, creep up on us, only fully and momentarily to be realized one day in the accumulated gray hairs reflected surprisingly back to us in that previously -‘all forgiving’ mirror . . . ."
Dr. Merenkov looks at how we therapeutically handle change in our patients’ lives and applies this to our own lives: "We, as psychiatrists, try to make sense of these ‘life-turning’ events and in the process hope to create even more change by a lessening of distressing symptoms via medication and/or psychotherapy treatments. No matter what our orientations, we ultimately offer a broadening of ideas of what it truly means to be human. We can, at times, endorse embracing change as a means to self-discovery, achievement of intimate connections with others, or acceptance of new responsibilities and limitations. At the same time, we recognize and validate grieving over what is lost or what must be relinquished. Whether patient or doctor, change is our life’s adventure, and our journey involves a lifetime of adaptation. Yet we must be vigilant observers of our adaptation to change in our roles as psychiatrists, if we are to serve our patients well. . . .
"We must embrace the challenges of change as an opportunity to evolve further as medical doctors. Yet, we must fully be aware of what we may lose on this journey to appreciate better the complexities of any decision made. We cannot sit on the sidelines with the excuse of waiting until the ‘dust settles’ on the current transitions, but rather must enter actively the process of trial and error in integrating old and new concepts. This does not mean that we avoid choosing a private stance in this deluge of change. After all, relativism can only go so far in providing actual, goal-oriented care. But do not let the ‘bandwagon’ of ideas that you choose be the only vision for your patients and yourself. The certainty of change teaches us to be more humble and open-minded about our positions; otherwise, our adaptation will be rigid and as fragile as those falling autumn leaves."
Laurence H. Miller, M.D., editor of the Arkansas Psychiatric Society’s newsletter Reflections, looks more concretely at how we can adapt to the changes in the health care delivery system. Writing in the fall 1997 issue, he emphasizes that psychiatrists must "capitalize on our special characteristics and seize every opportunity for improving patient care and collaborating with medical colleagues. . . ."
Doing so is particularly important, he writes, in light of the gatekeeper role many primary care physicians (PCP’s) have taken on and their unfamiliarity with the intricacies of diagnosing psychiatric illnesses. "In fact, recent statistics show that 60 percent of psychiatric disorders are treated by PCP’s, while 75 percent of all psychotropic medication prescriptions are written by PCP’s.
"The lesson from this seems to be that we must become indispensable to our PCP colleagues, teaching them about the identification and treatment of mental disorders and thus becoming their consultants for refractory patients. Psychiatrists need to be proactive and creative in developing collaborative models of care.
"Aside from psychopharmacology and education, are there other niches specific for us? Nowadays every discipline claims to be psychotherapists, but, again, we have specific training in the physical aspects of medicine, which we can use. Specifically, providing psychotherapeutic experiences for patients with concomitant physical illnesses and their complications, some of which can be chronic and life threatening, can enhance the quality of our patients’ lives and support the efforts of our medical colleagues."
Dr. Miller points out that his suggestions are but a few examples of ways in which psychiatrists can carve out an identity and role at a time when managed care is causing boundaries to become blurred.