COMMENTARY

The Future Is Bright: APA's Saul Levin on What's Coming in Psychiatry

Angela A. Coombs, MD

Disclosures

July 16, 2019

Editorial Collaboration

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This transcript has been edited for clarity.

Angela A. Coombs, MD: Hello. I'm Dr Angela Coombs with Columbia University's Department of Psychiatry and Medscape. We are here with none other than Dr Saul Levin, chief executive officer and medical director of the American Psychiatric Association (APA). Dr Levin, thank you for joining us.

Saul Levin, MD, MPA: Thank you for having me, and for choosing a great profession to go into in psychiatry. It will be the first of many great choices you make in the field of medicine in which you're practicing.

Coombs: Because we're here celebrating the 175th anniversary of the APA, I really wanted to ask you: Where do you see psychiatry going? What do psychiatrists in training or early in their career have to look forward to?

Levin: Thank you for noticing that we're 175 years old. We are the oldest medical society in the United States, 3 years older than the American Medical Association. We truly have a very long and distinguished history that you've entered into.

For a young, up-and-coming doctor such as yourself, let me tell you that I envy you for the practice you're going to be doing 10, 15, 20 years from now, because of the huge advances that are going to come in psychiatry.

I always tell the story that when I was in my third year of residency, the outpatient year, tricyclics and monoamine oxidase inhibitors were essentially the antidepressants of the time. Some worked, some didn't, and there were different side effects to consider. I began to think, Is this all we have in psychiatry? Then the first selective serotonin reuptake inhibitor came out and it revolutionized my thinking.

So when I say that I envy you, it's because I don't even know what you're going to be practicing in 15-20 years when you're in the middle of your career. Psychiatry isn't going away, and you are really going to enjoy seeing proper treatments come about that will help people who have a chronic disease. You will cure, I believe, some of the illnesses in psychiatry. So just think about how bright your future is going to be.

I sometimes wonder about the other professions that robotics are taking over. Well, it's not going to be us.

Coombs: Well, thank you. That got me excited for the future.

A Foundational Field of Medicine

Levin: Why did you go into psychiatry?

Coombs: It's interesting, because I think there's always this hope and fantasy that when you're working with patients, that you'll understand them and get to experience the very ways in which they see themselves and the world around them, the things that they're deeply passionate about and the things they're afraid of. However, many of the pressures of practicing medicine are such that it can be difficult to get to that point.

But even as a medical student, I came to realize that psychiatry is the very foundation from which everything else is built. Without being able to sit with your patient and understand the fundamental parts of their own humanity, there's only so much you can do. So to be charged with doing that in every single patient encounter made it, for me, the most remarkable work you could pursue.

Levin: And that's where the future is. When you think of medicine today, where electronic health records and prior authorizations begin to take away the pleasure of what we went into it for, psychiatrists will always be able to look their patients in the eye. It may be looking them in the eye via telemedicine, because there will be those advances as well, but that's why you have a wonderful profession to look forward to. It's about that connection and the help that you could be able to give.

Coombs: Thank you so much.

Levin: My pleasure. Thank you for being here at this event. You are one of our leaders, and I hope to one day see you become one of our elected leaders, and maybe even the president of the APA.

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