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)

1 comment:

  1. Why the wait at Ellis Clinic? Probably because everyone quits working there. They are always understaffed.

    For many years there was some turnover at the clinic but not much. Oh there could have been just a tad more turnover, some of the clinicians were burnt out or past their prime but even so there was cohesion, team work.

    Look at Ellis now. Eveytime I look someone is telling me they just lost their clinician again.

    This turnover is...well lets just say that the captain of the ship should be a mental health care worker. One who rose through the ranks.

    Mental health services is extrememly unique and the attention to the employees needs is crititcal due to the nature of and stress of the jobs they are doing.

    As far as Doctors go. I found the psychiatric nurse practitioner more in tune with my needs then a psychiatrist any day and I have been in treatment for decades. Both in the county public system and with private providers.

    I will never go to my general doctor for my psych medications. He/she has no real understanding of the dynamics of my illness.

    Don't misunderstand me. Medication is just a small part of my recovery and wellness. There are many ingrediants to make the pie.

    I recently had a discussion with some peers. There were 5 of us discussing the difference between a Psychiatrist and a Psychiatric Nurse Practicioner 4 agreed that they received better treatment for their illness from the PNP then from the Psychiatrist. Four out of five agreed Drs dispense too much medication. The fifth person has been with their current doctor for 27 years so they couldn't say since they never went to a PNP.

    Could it be the Doctors are learning the hard way they aren't Gods anymore.