The 15 Minute Medical Check: “Medical Management” vs. Care and Connection
New research published in a paper titled “Psychiatric Services in Advance,” (http://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201600133) by Dr. William Torrey of the Dartmouth Geisel School of medicine has reinforced the essential connection between doctor and patient, and discredits an unfortunate trend in psychiatric care for conducting 15-minute “medical check” visits. A general decline in talk therapy has been taking place for years, with one research paper (Mojtabai, Ramin, Mark Olfson, and David Mechanic. “Perceived need and help-seeking in adults with mood, anxiety, or substance use disorders.” Archives of General Psychiatry 59, no. 1 (2002): 77-84.) noting a 44.4% decline between 1997-2005. The overemphasis on medical management has not been a benefit to either doctors or patients, and many practitioners are working diligently to emphasize the most important parts of psychiatry: care and connection.
Not only do I concur with Dr. Torrey and his observations about “medical check visits,” but I should emphasize that I have never used that model in my practice. It is my belief that it is essential to use talk therapy to help understand a patient’s concerns. Simply acting as a “prescriber” who administers medications is not an acceptable way to practice Psychiatry.
Torrey’s research was conducted through PCORI (patient centered outcomes research institute) whose mission is to fund research leading to better-informed decisions about health care choices. While medication management can be one important element for patient care, it is a close, doctor-patient connection and personalized approach that is vital for good outcomes. As Dr. Torrey and his team reinforces, the most important role for a psychiatrist is to provide the type of care that can help people be more hopeful and live their lives in a productive and enjoyable way.
A Call to Dispense with the term “Medication Management Visit”
After completing the study, Torrey has advocated for the elimination of the term “Medication Management Visit” on the basis that it does not frame the healing process in a helpful fashion. Indeed, his assertion is that this phrase is in opposition to the entire concept of care, which should be the overwhelming point of emphasis for psychiatry.
In addition to focusing on the doctor-patient connection, Torrey believes that patient involvement is a key driver for success, noting “The more an individual can understand about the illness and be activated to manage his or her own illness and be part of the health care process, the better he or she does in the long run.” The practical side of this translates into something called a biopsychosocial plan that is a holistic approach to mental well being that is created by the patient and doctor working together.
The recent movement towards evidence-based recovery methods such as CBT (cognitive behavioral therapy) translates quite well into a more collaborative role advocated by Torrey. Although treatment plans for patients need to be highly personalized, Torrey and other researchers and practitioners note that the efficacy of talk therapy combined with medication is superior to either modality alone for treating many disorders.
From Passive to Active for Patient Success
Another expert, Dr. Erik Plakun, Associate Medical Director at the Austen Riggs Center in Stockbridge, Massachusetts, is a proponent of patient involvement as well, noting that moving patients from being passive recipients of care to active managers and co-creators of their own care plan should be a cornerstone of mental health. However the confidence, knowledge, and skills required for this transition can only be acquired through a personal approach and the aforementioned doctor-patient connection.
Torrey and others in the Psychiatric community recognize that it will take a concerted effort to eliminate the use of the 15 minute check-up, but that Psychiatrists who place a premium on a deeper understanding of patient needs will prevail over time.
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