John Oldham, M.D.
Psychiatry is part of the house of medicine . Evidence for the mainstream medical nature of brain disorders is abundant and persuasive. Whether medical homes or accountable
care organizations will be effective systems of care that help recapture the art of patient-centered care, or person-centered
medicine, remains to be seen. But psychiatrists must be at the health care table as active participants, as new models of
care are hammered out.
Psychiatric patients have a right to quality treatment . In extreme situations, psychiatrists must not shy away from active intervention when clearly indicated. Physicians do not
hesitate to intervene actively when a brain disorder called epilepsy leads to a grand mal seizure, or when a toxic delirium
produces combative behavior. There are many situations in which brain disorders known as psychiatric disorders are not recognized,
and patients are blamed for "behaving badly" instead of being guided to appropriate treatment to help them overcome disruptive
or distressing illness-driven behavior.
Fragmented care is not quality care . Too many patients have suffered at the hands of wasteful, ineffective, and poorly coordinated systems of care. Patients
encounter one new treating clinician after another, and even if continuity of some kind of care is accomplished, continuity
of meaningful treatment may not be. Psychiatrists need to lobby hard in support of quality, evidence-based, integrated treatment.
Research and education provide the best blueprint for our future . There is an explosion of knowledge about the brain, generating new ways to prevent and treat brain disorders. When the economy
falters and money gets tighter, clinicians and researchers must stand side by side to defend continued support for research
that will save money in the long run and improve the lot of patients.
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