Med checks: 15 minutes can make a difference
“How to avoid burning out and keep your spark” by Drs. Phil Bohnert and Anne O’Connell (Current Psychiatry, January 2006) offers welcome insights in this time of high stress for clinical psychiatrists. The authors’ analysis and suggestions seem worthwhile.
When discussing “External causes for burnout,” however, the authors took a cheap, unnecessarily harsh shot at the “15-minute” medication check as “probably the most demoralizing hazard.” That would only be true if the psychiatrist does not see the value of such brief interactions or cannot do them properly.
We can indeed help patients within 15 minutes and make empathetic connections by asking about their lives and what they value. Ignoring this skill slights the many psychiatrists who—because they want to serve the underserved but lack adequate funding—do quite well within that time frame.
Further, some patients, depending on their pathology and personality, prefer shorter visits. A truncated visit may help these patients stay in treatment.
Finally, the 15-minute visit is not all managed care’s doing: Brief med checks were common in community psychiatry long before the ascendance of managed care.
As the old saying goes for child rearing, it’s not (only) the quantity of time, it’s the quality of time together.
H. Steven Moffic, MD
The authors respond
We thank Dr. Moffic for his thoughtful comments. We do not wish to negate the value of the 15-minute medication check or its utility in increasing public access to psychiatric care.
It must be noted that psychiatrists have reported anecdotally and in the literature1,2 that such a brief visit can frustrate the desire to handle both medications and psychotherapy. For those who envisioned a psychotherapy-based practice, it may well remain a burnout hazard.
We welcome further discussion of the pros and cons of the 15-minute med check.
Phil Bohnert, MD
Anne O’Connell, MD, PhD
University of Hawaii, Honolulu
1. Regestein Q. Psychiatrists’ views of managed care and the future of psychiatry. Gen Hosp Psychiatry 2000;22:97-106.
2. Kalman TP, Goldstein MA. Satisfaction of Manhattan psychiatrists with private practice: assessing the impact of managed care. Medscape Psychiatry & Mental Health eJournal 1998;3(1).