Mohamed Dattu, MD Greensboro, Pa
Dr Dattu is an adult outpatient psychiatrist at Cornerstone Care in Greensboro, Pennsylvania.
Dr Pomerantz responds:
I agree entirely with Dr Dattu's observation that the widespread use of 15-minute medication management ses sions adversely affects psychiatrists’ ability to properly care for patients. A simple and useful examination such as the AIMS checklist does not get used because of time constraints.
Indeed, the term "medication management" does not accurately por tray what is supposed to happen in proper psychiatric follow-up sessions. As Dr Dattu nicely put into a time context, proper care is much more complicated. It is not just medications that psychiatrists are trying to manage; we are engaged with difficult illnesses and troubled patients. Any change in clinical status takes time to figure out. Is the problem a change in the severity of the illness, a loss of effectiveness of medication, medication side effects, a new comorbidity (somatic or psychiatric), or a change in life circumstances? Doing this clinical detective work, coming up with a new plan (including psychiatric measures and/or laboratory tests), and discussing the plan with the patient cannot be done in 15 minutes.
What I personally have done is to completely avoid 15-minute sessions (Psychiatric Procedure Code 90862). In my private practice, I never schedule less than 25 to 30 minutes for a follow-up session (Psychiatric Procedure Code 90805). Sometimes, but not often, insurance companies have called me to complain; after explaining my reasons, I am usually left in peace. The same thing happens in a clinic situation. My most important negotiation is the amount of time for follow-up sessions, which again has to be 25 to 30 minutes—or I will not work for that organization.
If more of us insist that we cannot and will not do 15-minute medication management sessions, it would improve psychiatric care and make the field far more attractive to medical students. We may also be less likely to be defendants in malpractice cases, because both our work and relationships with patients would improve.
Jay M. Pomerantz, MD
Dr Pomerantz is assistant clinical professor of psychiatry at Harvard Medical School in Boston.