There is much truth to the statement that “Medicine is rapidly changing in the United States,” and that these changes have been associated with a “loss of intimacy between doctors and patients.”3 This is simply a fact for all of medicine, and so let’s examine this trend a little more closely. Trends in healthcare, generally, could be said to proceed in this fashion:
o Technology never stops progressing;
o As technology progresses, much of the evaluation/treatment process becomes more rapid, and just as importantly...
o It becomes easier for people without specialized training to do. Again, a simple fact because the computer/new technology/etc can do the job more quickly, more consistently, and without a salary and healthcare benefits;
o Thus, the business of healthcare becomes progressively segmented and compartmentalized; o No area of healthcare is immune to the above process
Psychotherapy does not escape this sequence. Already, virtual psychotherapy is being developed and used. Soon, “avatar therapists” may be implemented.8 But until we develop true artificial intelligence, human beings will still be needed somewhere in the process. So in the interim, psychotherapy too will be distilled down to what “researchers” believe is its practical “essence.” Anything that cannot be accomplished in the 10 to 15 minute session can be given as a take home assignment to the patient. At some point, third party payers may decide that it is no longer feasible to pay even psychologists or social workers for what anyone with a bachelor’s degree can do. Is this sounding familiar? If so, it is because some of it is already happening.
But the question still remains: if we are not satisfied with this, must we accept it? Are we so genteel and apathetic as a profession that we will simply acquiesce? Will we passively assent to a lowering of what we believe is an acceptable standard of care for the patients we took an oath to treat?
Some may argue that my points here are too idealistic. Others may quarrel: “It is easy to proclaim such ideals when one does not have to live with the restrictions of my position.” To them I would say-–who is it that is keeping you imprisoned by these restrictions? Ultimately, this type of thinking provides no solutions and nurtures discontent. All that really matters are the answers to these questions:
1. Are your patients’ best interests being served?
2. Are you content practicing medicine according to the oath you took?
If the answer to either of these questions is no, then it may be time to change your situation. If we still wish to pursue our medical calling, then we must seek out the set of circumstances that brings us closer to what matters, and settle for nothing less. Such circumstances do exist (albeit maybe not in a particular desired location), and it is still possible to practice this amazing profession provided one is willing to adapt, stand by one’s principles, and stick to the path.
Psychiatry--it is time for you to awaken and return to your calling. If you went into psychiatry for the money, well. . .perhaps it is time to reevaluate that decision. If you went into psychiatry because you wanted to relieve suffering and explore the mystery of the human condition with your fellow travelers/patients, then it is time to stand by the code and ideals of your profession. And if, at some point, you find yourself worn down by the tedium of your routine, consider returning to the source of your principles, where you will find that the beauty and mystery have been awaiting you.
"Nothing will sustain you more potently than the power to recognize in your humdrum routine. . . the true poetry of life…”1
- Sir William Osler, MD