Fewer and fewer psychiatrists are able to do it all, delving into complexities of their patients' lives and minds during weekly psychotherapy visits, then taking out the prescription pad to manage their meds. It's a reality with which many psychiatrists have made their peace, particularly when the setting is conducive to true collaboration.
One of the study's co-authors, Dr. Ramin Mojtabai, works in a system at Johns Hopkins University that fosters periodic psychopharmacology assessment meetings that include himself, the patient, and the therapist–often a social worker by training–“who spends a longer time with the patient, and brings unique insights about the symptoms and the function of the patient.
“The therapist and the prescribing psychiatrist have the same goals in working with the patient. We are informed of each other's work, and that's a major positive point,” said Dr. Mojtabai of the Johns Hopkins Department of Psychiatry and Bloomberg School of Public Health.
After publication of the paper that he coauthored with Dr. Mark Olfson of Columbia University, New York, Dr. Majtabai said that he was approached by several psychiatrists who relayed to him that “even in a short, 15-minute visit, they feel that a lot of therapy work is accomplished.
“I agree with that,” Dr. Olfson said, particularly when occasional evaluative conferences are held to consider whether the goals of therapy are being met, or adjustments should be made–either in the medication or dose, or in the psychotherapeutic approach being employed. In real life practice, the “teamwork” concept varies widely, from scheduled patient conferences to “no real integration by design,” even when professionals share office space and patients, Dr. Mojtabai said.
The patchwork quilt of current collaborative practice models has never been systematically studied to see whether patients benefit, or even if money is saved in the long run when more than one practitioner provides care.
Well-designed studies could lead to best-practice models, he said.
“We don't know which groups of patients benefit from which settings,” or how often psychiatrists should see a patient receiving psychotherapy elsewhere,” Dr. Mojtabai said, adding that models of collaboration need to be studied as well.
At his Center for Collaborative Psychology & Psychiatry in Kentfield, Calif., Dr. Steven A. Frankel spends a great deal of time interacting with colleagues, a welcome change from the long hours he once spent conducting psychoanalytic therapy.
These days, he's a self-designated Med-Psych Coordinating Physician, doing a careful evaluation of each new patient, ordering psychological and medical testing, deconstructing the problems underlying symptoms, and assigning therapy to carefully selected consulting professionals such as social workers, school counselors, family therapists, psychopharmacologists, or primary care physicians.
“Personally, I enjoy this a lot more,” Dr. Frankel said in an interview. “I like working with other people. I love collaborating. It seems to be more honest to refer to people who are very skilled in what they do–more skilled in parts of this than I am.”
Serving as a coordinator of care requires a deep understanding of the patient, the diagnosis, and the system, Dr. Frankel added. “It's a relationship that has tremendous therapeutic significance.”
Dr. Frankel said that he is implementing the Collaborative Treatment Method into his practice, and intends to soon implement studies of its efficacy and practicality.
His hypothesis? The collaborative model will prove to be more cost effective than slap-dash arrangements implemented by managed care systems today, and more practical than the psychotherapy-driven psychiatric practices of the past.
“I think the patients will fare better, too,” he said.
By Betsy Bates. Share your thoughts and suggestions at cpnews@elsevier.com
Serving as a coordinator of care 'has tremendous therapeutic significance.'
Source DR. FRANKEL
The IPA tries to integrate skills and resources with the autonomy intrinsic to a fulfilling psychiatric practice.
Source DR. GOTTLIEB