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 1970s.

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 rarely reimbursable.

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 the services.

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 responsibility?


MEHMET FUAT ULUS, M.D.
 Erie, Pa.