Clinical Excellence in Psychiatry and Integrated Care: Can We Have Both?

I’ve been thinking about clinical excellence in psychiatry lately and comparing it to the “Skypeiatry” I’ve heard about at the 59th Annual Meeting of the Academy of Psychosomatic Medicine (APM), held in Atlanta, Georgia this year. Although the main theme was Bioethics at the Interface of Medicine and Psychiatry, there were quite a few presentations about integrated health care. Most presenters discussed the population-based approach of making mental health care more accessible to more people in primary care by leveraging collaboration between medical and psychiatric physicians using mental health care managers in a sort of stepped-care arrangement, often using electronic methods of communicating including Skype. The idea is to ensure evidence-based psychiatric treatment is available to those with comorbid medical illness in order to improve both medical and mental health outcomes. The assumption, which is borne out in numerous studies, is that most patients with comorbid and complex psychiatric and medical illnesses don’t get any mental health treatment under ordinary treatment-as-usual paradigms.

The collaboration between the care manager and the psychiatrist is critical because the primary care doctors are the team leaders in the integrated care model and will continue to be the main prescribers of antidepressants–which they’ve been doing anyway for years. The difference is that closer communication between primary care and psychiatric physicians and closer followup along with systematic outcomes measurement utilizing a web-based patient registry, and accountability for patient satisfaction improves care while reducing costs of both medical and psychiatric illness.


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  1. You can’t have clinical excellence with 1 year wonder noctors:


    • I’m assuming you’re talking about the Physician Assistant in Psychiatry Fellowship at The University of Iowa (judging from the link to its description on the UI website) and possibly all non-MD, non-DO clinical medicine training programs, on principle. I also did not change the spelling of “noctor” in your message in case that also meant something important. I have personally worked with physician assistants, nurse practitioners and other medical team members and my impression is that their performance is similar to that of physicians in that it tends to run on a spectrum, ranging from excellent to mediocre or worse. In my opinion, that’s because excellence is a habit which we can choose to pursue–or not.

      Jim Amos, MD


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