Maintaining Leadership Role

I am an early career psychiatrist who has recently entered the world of private practice. Leadership came naturally to me, and I was enjoying my previous work of being a unit medical director within the four walls of inpatient psychiatry until the bug of stagnation started to bite. After the shift to outpatient psychiatry, I soon learned that our patients had been trained by their therapists and their insurance companies to regard their psychiatrists as the pill provider only. What shocked me most is that most of my colleagues had willingly accepted that role, which allowed our non-M.D. mental health workers to decide on the multiaxial DSM diagnosis, dictate therapeutic interventions, and sometimes even recommend names of medicines they would like us to prescribe.

One example I would like to give is of a young gentleman referred to me by his therapist. The therapist had been seeing him for treatment of adjustment disorder and felt that an SSRI was now indicated as the patient was worsening. In my evaluation it was obvious that this was a case of postconcussion disorder, and now he had developed posttraumatic stress disorder.

Of course he had anxiety and depression, but if I had not taken a leadership role and utilized several years of my medical school and residency training, this patient would have gotten lost in the system of “let’s just give him an SSRI.”

Arriving at my conclusion involved phone calls to his primary care physician and therapist, getting an MRI and neuropsychological testing, giving psychoeducation and medications, and filling out several forms. Yes, it was a very time-consuming process but also equally gratifying for me and the patient. I maintained my role as the M.D. and not just someone who happened to have a license to prescribe pills.

In this era of managed care, it is easy to fall in the trap of becoming a nonentity med-check doctor and shun the dirty work of filling out forms, making phone calls that end up being irritating, and answering our patients’ queries to our non-M.D. colleagues, but we must be careful that we do not give away our role as a medical doctor. When our patients are asked who their psychiatrist is, they should be able to remember our names instead of having to respond, “I can’t remember his name since he hardly ever talks to me” or “I see him two or three times a year only for prescriptions.”

Let us work hard to provide quality service so that our patients and our colleagues are able to acknowledge us as committed professionals. That has been my recent challenge and has cured my bug of stagnation.