PUBLISHED IN GOLDEN JUBILEE SOUVENIR OF BYJEMEC, B J MEDICAL COLLEGE, PUNE IN 1996.
Friday, August 31, 2012
Sunday, August 26, 2012
THE WORLD AROUND YOU
I have worked in private practice as well as in an institute. My impression is that the amount of work a psychiatrist gets does depend on the setting of work.
In an institute, I have observed that the threshold for asking a Psychiatrist to get involved is rather low. We get referred any case and every case. Hence the workload is considerably high. Whereas, in private practice the referrals are slow to come. Even serious and purely 'Psyhciatric case' like suicide attempts and psychoses are retained by doctors from other specialties. Thus cases are fewer.
One explanation for this is due to the desire to work less and also to make more money; both being at the cost of the patient's welfare.
In the first instance, the patient would benefit from continuing care of the Physician/ orthopedician, etc. But the salary remaining constant, this doctor has nothing to gain from keeping the patient in the wards and increasing his/ her workload. This doctor also has a culture of concrete thinking, where seeing ONLY is beleiving and quality of life has no meaning. But if patient is not accepting his explanation that everything is ok, and the relatives refuse to take the patient as he/ she is still distressed or troublesome, the doctor bounces off the patient to the Psychiatrist. No Psychiatrist can refuse to take care of a patient who is obviously uncomfortable. So the patient with many medical problems, and just mental symptoms (not mental illness) gets shifted to the Psychiatry ward. Now the Psychiatrist and the patient have to keep begging the referring doctor to come regularly and have a look to maintian the physical status. This gives the additional incentive of 'ego massage' to the referring doctor, who believes that Psychiatrists are lesser mortals and anyway dont have any work to do.
The scenario is much different in private practice. Every doctor believes that Psychiatric disorders are not disorders at all and counseling will set everything alright. They are scared to use psychiatric drugs in proper doses, but since they are so intelligent they will open some book, find a few names of psychotropics and discharge the patient with a scolding and 'good advice' (which is their version of counseling). After all by treating the patients themselves, and keeping them ill as long as possible, there is money to be made. When the patient becomes fed-up or very ill, they will, very reluctantly refer to the Psychiatrist. By this time the disease has progressed to such an extent that it is a tuff situation even for a Psychiatrist and the improvement proceeds slowly, partially or not at all. Then they confirm their delusion that 'Psychiatrist know nothing and do nothing' and malign them.
I feel every professional should spend some time educating themselves about the thresholds for referral to Psychiatrists. They can just make it a habit to talk to the Psychiatrists about the cases they have referred; over the years they will learn. Of course, one can do nothing aboout unscrupulous persons who dont want to refer patients.
I am sure this discussion applies to referrals between other specialties also.
In an institute, I have observed that the threshold for asking a Psychiatrist to get involved is rather low. We get referred any case and every case. Hence the workload is considerably high. Whereas, in private practice the referrals are slow to come. Even serious and purely 'Psyhciatric case' like suicide attempts and psychoses are retained by doctors from other specialties. Thus cases are fewer.
One explanation for this is due to the desire to work less and also to make more money; both being at the cost of the patient's welfare.
In the first instance, the patient would benefit from continuing care of the Physician/ orthopedician, etc. But the salary remaining constant, this doctor has nothing to gain from keeping the patient in the wards and increasing his/ her workload. This doctor also has a culture of concrete thinking, where seeing ONLY is beleiving and quality of life has no meaning. But if patient is not accepting his explanation that everything is ok, and the relatives refuse to take the patient as he/ she is still distressed or troublesome, the doctor bounces off the patient to the Psychiatrist. No Psychiatrist can refuse to take care of a patient who is obviously uncomfortable. So the patient with many medical problems, and just mental symptoms (not mental illness) gets shifted to the Psychiatry ward. Now the Psychiatrist and the patient have to keep begging the referring doctor to come regularly and have a look to maintian the physical status. This gives the additional incentive of 'ego massage' to the referring doctor, who believes that Psychiatrists are lesser mortals and anyway dont have any work to do.
The scenario is much different in private practice. Every doctor believes that Psychiatric disorders are not disorders at all and counseling will set everything alright. They are scared to use psychiatric drugs in proper doses, but since they are so intelligent they will open some book, find a few names of psychotropics and discharge the patient with a scolding and 'good advice' (which is their version of counseling). After all by treating the patients themselves, and keeping them ill as long as possible, there is money to be made. When the patient becomes fed-up or very ill, they will, very reluctantly refer to the Psychiatrist. By this time the disease has progressed to such an extent that it is a tuff situation even for a Psychiatrist and the improvement proceeds slowly, partially or not at all. Then they confirm their delusion that 'Psychiatrist know nothing and do nothing' and malign them.
I feel every professional should spend some time educating themselves about the thresholds for referral to Psychiatrists. They can just make it a habit to talk to the Psychiatrists about the cases they have referred; over the years they will learn. Of course, one can do nothing aboout unscrupulous persons who dont want to refer patients.
I am sure this discussion applies to referrals between other specialties also.
Friday, August 3, 2012
WHAT THIS BLOG IS ABOUT?
This blog is for doctors and about doctors. It will contain topics about the medical profession, and about psychiatry.
Subscribe to:
Comments (Atom)