Tuesday, September 29, 2015

neuroscience and technology have far outpaced the training and practice of psychiatry...,


behaviorismandmentalhealth |  Joel Yager, MD, is a Professor of Psychiatry, University of Colorado at Denver School of Medicine.  He started his career as a US Army psychiatrist in 1969, and has held a wide range of clinical and teaching positions in the intervening years.  He has received numerous awards, including lifetime achievement awards from the National Eating Disorders Association (2008) and from the Association for Academic Psychiatry (2009).  He has published more than 200 peer-reviewed papers, many of which are concerned with the training of psychiatrists.

In January 2011, Dr. Yager published The Practice of Psychiatry in the 21st Century: Challenges for Psychiatric Education, in the journal Academic Psychiatry.  This paper received favorable comment from Jeffrey Lieberman, MD, President of the APA, in the article Training the Psychiatrists of the Future, in the November 26, 2013 issue of Psychiatric News.  As my regular readers will know, I am an avid fan of Dr. Lieberman’s, and it is my belief that anything he recommends warrants close scrutiny.

The stated purpose of Dr. Yager’s article is:

“To consider how shifting scientific, technological, social and financial pressures are likely to significantly alter psychiatric practice, careers, and education in the 21st century…”

and to review

“…trends and innovations likely to have an effect on tomorrow’s psychiatrists and their educators.”

It’s a wide-ranging and optimistic article.  Here are some quotes, interspersed with my thoughts and observations.
. . . . . . . . . . . . . . . .

“Measurement-based disease-management care will progress as even chronically ill psychiatric patients increasingly use computer-based tools in waiting rooms to rate their clinical status before office appointments.”

From his use of the terms “disease” and “ill,” it is clear that Dr. Yager is immersed in the medical model.  There is nothing in the article to suggest even an awareness of the fact that this model is under considerable criticism at the present time, nor that this reality may have some relevance for psychiatrist training.

Is there a hint of condescension in the phrase “even chronically ill psychiatric patients”?  And is having the client fill in boxes on a computer screen in the waiting room an improvement over talking to him in the office?  Will the 15-minute med check be reduced to 10 minutes?