Tag: medicine

Oh No You Don’t

Medical docs, you don’t get to run over a patient and their therapist with your assumptions just because you believe you can.

Yesterday one of my long term clients called me to ask for a psychiatrist referral. The message was a puzzle, so I called her back to learn the details.

She had been in to see a doctor for medication for an infection. After that examination, blood work and diagnosis was over, the doctor asked my client about an older mental health diagnosis that was in the chart. “Well, I see that you were diagnosed XXX in the past.” “Yes,” my client answered, “but my current therapist assures me I don’t have XXX anymore.” Well, that information was ignored. My client was ushered in to see yet another physician who “specialized” in mental health issues. He proceeded to give her a brief screening, and in a few minutes told her that while she probably didn’t have XXX anymore she probably had ADHD.  She should see a psychiatrist to confirm the diagnosis and get appropriate medication.

This is an abuse of power, as far as I’m concerned. I have seen this client dozens of hours over a span of more than two years. I have more training and experience in mental health diagnosis than these doctors ever will, and I am the health professional on record who is providing mental health care. If they had bothered to LISTEN to the client about her experience, paused to consider my license and the limits of their training, my client would have been spared their authority run amok.

I’m just glad my client called.  I could assure her she didn’t need screening for ADHD, and save herself the $300 + she would have spent to see a shrink for a disorder she doesn’t have.

What is astonishing to me? These doctors believed they had the whole picture on our patient after 10 minutes, and ran right over her own health care history. Medical arrogance is everywhere, but here, for this one person, is a stunning example of it when it comes to mental health care.

Medical docs, I’ll make you a deal: I won’t try to set broken legs or cure infections if you don’t try to heal the mind with 5 questions and your electronic prescription software. You’re out of your league, believe it or not (and I know you don’t).

Taking Charge of our own Health

As a nation, we spend a LOT of money on health care. It’s expensive for a couple of reasons: the amazing discoveries, technologies and research which allow for astonishing cures and healing of human suffering is expensive to create. And secondly, because we Americans have treated health care not as a right, like public education, but as a service that we purchase, like energy or food.

Because of the early national decision to treat health care as a service, the pace and cost of advances in medicine has out-stripped most Americans’ ability to pay for it themselves. Hence, the explosion in the last century of our dependence on health insurance. We have become so dependent upon it as an addition to our pay, most of us have come to think of health care as something that our insurance pays for, as if it were an additional source of revenue to our family instead of a support to the health care we purchase.

This model leaves the poor, homeless and unemployed dependent upon our hospitals’ emergency system to receive the health care they need. And because treating normal health issues in the ER is like sending a battle ship to take you fishing, this solution is not much of one. But we are so wedded to the health care as a service model, the only solution that the best minds of our day can come up with is to provide universal health care coverage.

What makes me a bit crazy about this solution is the increased dependence we all have on insurance companies. And with this increase in dependence, comes a pressure to keep costs down as they add members who may use more insurance on average than others. So while more of us are covered, the coverage shrinks in response.

While this may be good for most Americans, it has not been good at all for mental health providers. We are the lowest paid health care providers as a group in the country, and reimbursements for our work are getting smaller and smaller each year. More of us are leaving our contracts with the large insurers, and some of us begin our private practices without signing contracts at all, focusing on serving the most people we can as Out-of-Network, or non-preferred professionals.

Mental health, one of the most important of the healing arts to learn and master, is slowly being pushed out of the health care arena. If you have tried to get an appointment with a local psychiatrist lately, you will know exactly this first hand. The recession has made this shortage worse, as the larger health systems cut back on mental health clinics and out-patient therapists.

While we continue to try to solve this growing crisis, we each need to consider how important our health is to us and act proactively. We need to stop expecting doctors to fix things after we have done willing damage to ourselves either by inactivity, abuse of alcohol, food, drugs or other things we ingest. We need to limit the excesses we have come to demand of medicine, whether that be for antibiotics, plastic surgery or that third or fourth expensive test. And we need to put our money where our personal priorities are, and be willing to pay a larger portion of our own care in our daily budget.

We have grown fat, literally and figuratively, at the table of insurers. We are bloated by the expectations that medicine, physical and mental health care are paid by someone else. If it is essential to our lives, we need to add it into our budgets, just like we do when we put gas in our cars and and food on our tables. Like it or not, we buy the things we need in our economy, and we must grow to understand that all this health care is not someone else’s bill, but our own.

“In insurance we trust” could be the motto of many Americans. As more of us receive coverage, more of our income will need to be set aside for health coverage. And that is as is should be, if only so long as we commonly consider health care a service we pay for, and for which we should have choices as consumers.