The other side of the couch

How often do we visit our health care provider only to leave disappointed with a handful of prescriptions?

Is anybody truly listening to us? Is medication the first option or the only option discussed? How much time is spent with the provider? Do we see the same provider every time?

One of the key indicators of positive health outcomes is the patient’s relationship with the provider. With an average of seven minutes per patient, how likely is it that a relationship will develop?

The model of care for mental health went from years spent on a couch during psychoanalysis to three to five sessions of brief therapy. Patients saw one provider — the psychiatrist — who had the ability to prescribe medication as well as the therapy.

Now, the process may involve three to four providers, the initial visit to the primary care physician for the referral to a psychiatrist (medication only) and a therapist (counseling only). In cases of chronic illness, a case manager or social worker may get involved to coordinate care between the PCP, psychiatrist and counselor (coordination of care works better in theory than in practice).

How did it come to this? How quick are we to point fingers at the providers?

One assumption is that the providers are in control of how they run their practice and they make the rules. Another assumption is that the patients want the quick fix to the problem and are not willing to put the time into therapy. Both assumptions may be true, but the main driver of the evolution of behavioral health care is the insurance industry working hand in hand with PhARMA.

We have either experienced the difficulty in trying to navigate the system or listened to somebody complaining about how awful their experience was. We know the story well. How many of us have questioned what it is like for the doctor, the therapist or the nurse practitioner who spent thousands of dollars and put in countless hours to earn the credentials to help people? Probably not many, due to the assumption that providers have the upper hand.

I think the last time I went to see my doctor I diagnosed myself. She was to busy inputting data into her laptop. It would be nice to see a movement from doctors refusing these types of standards and focusing on the ins and outs of patient care.

This Saturday we will be talking to a psychiatrist who can tell us what it’s like on the other side of the couch. Dr. Mike Yasinski will give his perspective on the evolution of behavioral health care.