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Comments and Controversies

Managed care woes

Vol. 10, No. 08 / August 2011

Regarding Dr. Nasrallah’s insightful editorial (“A skeptical view of ‘progress’ in psychiatry,” From the Editor, Current Psychiatry, June 2011, p. 18-19): Since the late 1980s and early 1990s, the Employment Retirement Income Security Act, has enabled managed “care” to exist, with failed attempts to repeal or limit the act. Managed “care” has worked hard to change our language, such as “primary care physician” instead of physician or doctor and “behavioral health” instead of psychiatric or mental health care. These changes minimize our importance, influence, and reimbursements as well as the medications and treatments we use. When it was obvious what was happening, we abdicated our responsibility and control to the kind of people Dr. Nasrallah described.

There will be more cuts on reimbursements and limits on us unless we say “no.” We are not allowed to organize, physicians in Congress have not helped, and our elected professional organization leaders have little influence. We can give in and accept the “inevitable,” but the Hippocratic Oath seems to preclude such irresponsibility. We can refuse to treat anyone, except in emergencies, unless we choose to do so in good conscience. We need to change and the law has to change. The people who control our health care are evil, immoral, and venal; why should they be dictating care?

Gerald A. Shubs, MD
Butler Behavioral Health Services
Hamilton, OH

Dr. Nasrallah responds

Thanks to all my colleagues who took the time to read and express their views, to agree or to challenge the tenets in my editorial that lamented the lack of progress in certain practice aspects of psychiatry. Current Psychiatry is a marketplace of updates, ideas, suggestions, critiques, and rebuttals. It is interesting psychiatrists who have worked for a long time with seriously mentally ill patients in hospitals or the community seem to feel the pain of the lack of steady progress and/or the slippage in some areas, while those who identify with the managed care model of care see things differently— ie, managed care is, in fact, progress.

We psychiatrists evaluate and treat patients in very diverse settings and perceive things through different prisms, which is why we have disparate views. No one has a monopoly on the truth, but we all have important common ground: we all share an intense loyalty to our suffering patients, and we all share pride in our noble profession regardless of its ups or downs. We know in our hearts psychiatry remains indispensable for the well-being of all citizens. Pass it on…

Henry A. Nasrallah, MD

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