Patients' Cultural and Spiritual Beliefs Influence Their Diagnosis, Treatment, and Management -- From APA 2008: May 7, 2008

Andrew N. Wilner, MD

Disclosures

May 08, 2008

In This Article

The Myth of the Med Check

Increasingly more psychiatrists are spending significantly less time with their patients, in part because of reimbursement issues and partly due to psychotherapy being outsourced to other providers. As a result, many psychiatrists have become "psychopharmacologists," in charge of medication refills and side-effect surveillance.

Charles Nemeroff, MD, PhD,[4] Professor and Chairman of the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, argued that there are many reasons why psychiatrists need to spend more time with their patients and be more than just psychopharmacologists. Brief encounters are unlikely to create a strong therapeutic relationship and may inhibit the patient from sharing important symptoms or concerns. A short "med check" visit, typically 10 or 12 minutes, provides insufficient time to thoroughly address comorbid medical illness, medication side effects, and symptoms of suicidality. In addition, medical disorders such as renal disease, dementia, and Parkinson's disease may be responsible for depression and may be overlooked within the constraints of a brief visit.

According to Dr. Nemeroff, 1 out of 3 patients who see a psychiatrist has no other physician, increasing the psychiatrist's burden to address other health issues, such as smoking cessation, exercise planning, abstinence from substances, and a healthy diet. Patients with mood disorders and schizophrenia suffer an increase in medical morbidity and premature death, with a loss of 20-30 years of a normal life span. Medication side effects, such as the metabolic syndrome from antipsychotics, contribute to this excess morbidity and early mortality. During follow-up visits, psychiatrists need to have sufficient time in order to check for adverse events of treatment, such as hyperprolactinemia; address elevated glucose, lipids, and high blood pressure; monitor the response to therapy of the presenting psychiatric complaint; reassess the diagnosis; and be alert for suicide risk.

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