Dr. Peter J. Weiss

I don’t know if you saw this New York Times arti­cle on psy­chi­a­try recently, but it’s worth read­ing in its entirety.

The hard-hitting piece reveals how mod­ern psy­chi­a­try has become a pro­fes­sion that sim­ply med­icates patients rather than helps them to change.

Here’s psy­chi­a­trist Dr. Don­ald Levin explain­ing that, “I had to train myself not to get too inter­ested in their [his patients] prob­lems and not to get side­tracked try­ing to be a semi-therapist.”

Accord­ing to the report he actively resists help­ing patients to man­age their lives bet­ter.

Recent stud­ies sug­gest that talk ther­apy may be as good as or bet­ter than drugs in the treat­ment of depres­sion, but fewer than half of depressed patients now get such ther­apy com­pared with the vast major­ity 20 years ago.

So, what does the doc­tor do instead?  Pre­scribe pills of course.  The arti­cle goes on to report that:

• Brief con­sul­ta­tions have become com­mon in psy­chi­a­try, said Dr. Steven S. Sharf­stein, a for­mer pres­i­dent of the Amer­i­can Psy­chi­atric Asso­ci­a­tion and the pres­i­dent and chief exec­u­tive of Shep­pard Pratt Health Sys­tem, Maryland’s largest behav­ioral health sys­tem.  “It’s a prac­tice that’s very rem­i­nis­cent of pri­mary care,” Dr. Sharf­stein said. “They check up on peo­ple; they pull out the pre­scrip­tion pad; they order tests.”

• Com­pe­ti­tion from psy­chol­o­gists and social work­ers — who unlike psy­chi­a­trists do not attend med­ical school, so they can often afford to charge less — is the rea­son that talk ther­apy is priced at a lower rate. There is no evi­dence that psy­chi­a­trists pro­vide higher qual­ity talk ther­apy than psy­chol­o­gists or social work­ers.

• Recent stud­ies sug­gest that talk ther­apy may be as good as or bet­ter than drugs in the treat­ment of depres­sion, but fewer than half of depressed patients now get such ther­apy com­pared with the vast major­ity 20 years ago. Insur­ance com­pany reim­burse­ment rates and poli­cies that dis­cour­age talk ther­apy are part of the rea­son. A psy­chi­a­trist can earn $150 for three 15-minute med­ica­tion vis­its com­pared with $90 for a 45-minute talk ther­apy ses­sion.

This is a clear exam­ple of what’s wrong in med­i­cine today.

Talk ther­apy helps indi­vid­u­als change their think­ing and their behav­ior.  It assists them in elim­i­nat­ing the causes of their prob­lems.

It’s inex­pen­sive and widely avail­able, but doc­tors get paid more to pre­scribe med­ica­tions, which help the symp­toms while not nec­es­sar­ily cor­rect­ing the cause — and expose the patient to poten­tial side effects.

So despite the fact that talk ther­apy is safe, effec­tive and cheap, most patients don’t get it.  Amaz­ing!  But also very sad!

Sad for the patients and sad for the doc­tors like Dr. Levin who knows he could be help­ing his patients more with talk­ing but chooses not to do so — based on the money.

The larger les­son is that we can’t trust the health­care sys­tem to do what’s right for us.  We must be informed patients.  Let’s exam­ine our options and ques­tion our doc­tors.  Let’s be in charge of our own health and health­care.  We can do it!