“Psychiatrists may be the last batch of physicians who are still granted a luxurious amount of time with patients.”
So says Maria, a psychiatrist who blogs over at intueri.
And because time is so undervalued without our health system, some doctors relying on psychiatrists to counsel patients in the hospital. She cites an example with surgeons, saying that “it is entirely unfair to both the patient and the psychiatrist for the surgeon to completely emotionally ‘turf’ the patient.”
Are surgeons better off letting psychiatrists, who may have more experience in the area, guide patients through times of suffering? Or are they, in Maria’s words, asking he psychiatrists to have a doctor-patient relationship for them?
In the end, it comes down to how time is undervalued, and thus, weakens the doctor-patient bond. And until we find a way to rectify this, I’d expect the trend of emotionally turfing patients to continue.
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- Not all psychiatrists take drug money
- You’re spending too much time with patients
- Psychiatrists
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Likely because many of them can afford to spend more time. The majority in my area accept no insurances, and charge $150 per 30 minutes. They also often have lower overheads (many work out of their homes or non-medical office space) and have limited staff.
I remember a case where I got consulted to see a patient in the hospital after a knee replacement. I am family medicine as we do not have in house psychiatry except for extremely sick patients. The orthopedice surgeon called and said, “I need you to see Ms. Smith. I went in to check on her knee this morning and she just started crying.” He did not ask why she was crying but simply turned around, left the room, and called me. She ended up simply being overwhelmed by her surgery and rehab for her knee but overall OK. He could have figured it out but did not even try. He had more expensive surgeries to do.
This assumes there are psychiatrists around to do the counseling…in many community hospitals, psychiatrists are in short supply (and a child psychiatrist is as easy to find as Bigfoot!). Even if they are available, they are so busy running around the hospital consulting on cases of severe mental illness, such as untreated bipolar, drug addiction, delirium, suicidal depression, and dementia that to counsel a patient almost seems like a waste of their resources, in that the time they would be available to counsel an otherwise normal patient who is overwhelmed about a knee replacement is time taken away from an agitated and delirious alcohol withdrawal case who is screaming about being eaten by little green men crawling in his skin…one has to choose one’s battles!
Greg,
I don’t think psychiatry should be consulted for this problem. I think that the orthopedic surgeon could have taken 5 minutes to ask what is wrong. I think having someone just listen to her could have helped. He had no time for it. Why? Global coverage for the surgery, time is money, and there was no money listening to the patient.
No money to listen to the patient.
Has it really come to this – that common courtesy requires compensation – that physicians believe that every word from their mouths, every emotion expressed, every hand pat requires compensation?
Who is training these orthopedic surgeons that they believe they are so entitled to wring every cent they can from each and every patient and every moment of everyday? Their business is care of the patient – not fix the knee. Included in care of the patient is allaying fears, making sympathetic noises (even if insincere, it can be faked), taking a moment to acknowledge the humanity of what they do. And don’t tell me that they don’t make enough money to allow for such care.
Such behavior must be reported and sanctioned – perhaps fines along the lines imposed on professional athletes when they fail to behave professionally is in order.
The money could go into a fund for indigent healthcare. Imagine the rush to take proper care of patients if this were the case.
The orthopedic surgeon with the crying patient is receiving a global fee that is supposed to cover pre and post op care within the scope of his practice that is related to the surgery. Crying is is not a psychiatric crisis. It is at least with some patients a normal and expected part of being sick, in pain, and undergoing scary procedures. And the initial step of the appropriate medical response–to take 5-15 minutes to listen and comfort, is a part of the minimal competency of every physician regardless of specialty. The orthopod is either one of those emotionally dwarfed individuals who is freaked out by crying females such that he can only flee in panic, or just too greedy collected those fees by doing as many cases as possible to take the time to actually earn them by providing all of the care that he is being paid to provide.
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