Tuesday, December 22, 2009
Why not let clients see a doctor first, not a social worker?
Why does treatment in a mental health clinic not conform to treatment in any other health clinic where you come in to see a doctor first rather than a social worker? Are we so short on psychiatrists? Aren't general physicians just as capable to handle psychiatric patients today where the main treatment is to prescribe pharmacy? The psychiatric profession has had to learn about these drugs and so can the general practitioner. Besides, county mental health clinics and publicly subsidized hospital clinics, like Ellis, are often staffed nowadays with nurse practitioners and physicians assistants,who have power to prescribe medicines but may lack the rounded experience of a psychiatrist. Look at this—we are told that patients with symptoms of mental disorder other than a florid episode will go to the government-subsidized Hometown Health Center on State Street and see a doctor at first visit, usually same day they show up. In contrast, someone even with serious symptoms trying to see a doctor at the Ellis mental health clinic may be forced to wait 30 to 60 days and then will just see a clinician at the outset. For an emergency they'd suggest you go to the hospital emergency room. The therapist who intercepts you at the clinic needs to assess your condition before referring you on to a doctor. Why do we do this in the publicly assisted clinics but not a psychiatrist's office? The doctor makes his own assessment, keeps his own charts and records, makes the patient “his”, not the clinician's. But the clinician continues to see the patient, delving into social and adjustment issues called counseling. The counselor talks more to the patient than the doctor does, which helps patients feel more comfortable, even if some problems can't be talked out. And this counselor becomes the client's advocate, or not, to line up future doctor visits and other forms of assistance. It's a strange world in which public psychiatry is practiced. (Roy Neville)