Big changes in practice, but none for the better

Dr. Nasrallah’s approach to psychia­try, especially to the real problems confronting us, is both professionally astute and realistic.

I have been in practice for more than 60 years and have seen tremen­dous changes—none for the better— in the intrusion of insurance tyranny and government overregulation. Dr. Nasrallah’s comments about obstacles created from the system, regardless of so-called “parity,” hit the mark. The insurance companies control everything by setting fees so low and documentation require­ments so high that there is little time to focus on the dynamics of the patient population. Unqualified peo­ple are deciding whether or not the medications we prescribe will be paid for.

To illustrate what I think of some of the changes, here is what I have observed:
• Electroconvulsive therapy for severe depression has been “rediscovered,” but for decades those of us who used it selectively, with good results, were considered to be practicing quackery.
• Dr. Nasrallah’s recent article on devel­opment of immediate treatment plans for a patient given a diagnosis of schizophrenia (Current Psychiatry. 2015;14(5):32-34,36-40,42 [http://bit.ly/1GLGtrZ]) reminds me of a time when it was thought that you couldn’t diagnose schizophrenia until symptoms had been present for 6 months. (Had they ever heard of the work of Eugen Bleuler?)
• At a national meeting 20 years ago, I raised the question of why every other specialty of medicine stressed early diagnosis and treatment but psychiatry did not—and, instead, was doing the opposite. The speaker did not have the cour­tesy to answer my question.

Keep up the good work! We need people such as Dr. Nasrallah to educate the public about how government and insurance companies are destroying our specialty.