Let’s talk about poor concordance between diagnosis and treatment!
I enjoy the intellectual insights in Dr. Nasrallah’s From the Editor essays in Current Psychiatry. For future editorials, I suggest a few topics for him to discuss:
• There is poor concordance between diagnosis and treatment by psychiatrists, compared with other medical specialties, because we do not have tests or measures to employ both before and after treatment. In other words, we have not standardized our evaluation or treatment. Despite my 4 videos on YouTube and an e-book, Standardizing psychiatric care, I have not received an enthusiastic response or discussion from the American Psychiatric Association (APA) or academic psychiatrists— knowing that this step is crucial to integration of care with primary care physicians (PCPs) and other physicians. We must be a leader in training PCPs and other clinicians about how we care for our patients.
• The practice of medicine is local. In this region of North Carolina, however, the private practice of psychiatry is disappearing. It is almost impossible to start a successful practice, primarily because of managed care.
• The goals of psychiatric treatment have not been adopted by all professionals. This includes returning patients to optimal functioning at no less than 80% to 90% of their capacity in self care and professional, school, social, and home settings, and to having at least 85% of psychiatric symptoms under control, with the least possible number of medication side effects.
• Treatment of psychiatric symptoms is highly individual, and therefore the dosage of each medication must be titrated carefully. This important aspect of treatment has not been well-emphasized in training or by the leadership of the APA.
• Treatment in psychiatry is a combination of the right medication and lowest effective dosage to minimize side effects. Therefore it is a polypharmacy, and we must accept it and educate patients accordingly.
I hope that Dr. Nasrallah’s influential editorials will shed light on these topics, and begin a national and international debate on these issues.
V. Sagar Sethi, MD, PhD
Carmel Psychiatric Associates, PA
Charlotte, North Carolina
