While nobody can deny the success of APA in so many areas including, but
not limited to, helping to achieve parity coverage of mental health care,
patient care still suffers, at times even more so than it did in the early
When I started psychiatry residency training in 1971, there were no health
insurance preauthorizations and formulary restrictions and few government
rules and regulations. No one other than my colleagues advised me what to do
relevant to delivering high-quality care. I could prescribe any medication I
thought would be serving the best interest of my patients. My patients were
working in those times.
I was able to hospitalize patients whenever hospitalization was needed. No
one pushed me to discharge patients prematurely because of authorization
limitations. I was each patient's therapist, counselor, and spiritual
consiglieri and a part of his or her family, applying different approaches
based on the patient's capacity and needs.
I supervised recreational therapists, occupational therapists, and music
therapists. I founded group cinema therapy sessions. Such services are not or
Today, patients come to my office, often with no money and no insurance;
many do not even meet the criteria for residency in the region or state, and
thus are not eligible for assistance. How can I help these patients if all I
am able to do is prescribe medications in a 15-minute appointment?
As far as drug samples are concerned, some clinics prohibit their use.
Those that do use drug samples do not have any guarantee that the supply will
be steady. While patient assistance programs are extremely valuable for
indigent patients, some administrative and financial factors may still hinder
Once the doctor-patient relationship is established, then I am responsible
for the patient's well-being. What autonomy, credibility, resources, and other
strengths do I have left in my medical bag in balancing this
MEHMET FUAT ULUS, M.D.