Shortage of mental illness care leading to health crisis
Here is another shocker…Government health care doesn’t work in the US. Our system is broken and only getting worse. Extra workloads to meet the government’s rules and protocols, but no time allotted to provide education, review charts, or discuss cases, and let’s not forget no extra compensation. As if EMRs are not bad enough, let’s tack on some additional paperwork as well because that makes all the sense in the world. And then let’s get some militant bureaucrats to tell us how to do our jobs. Thanks, but no thanks. The sad truth of all this is exactly what this article states — miserable doctors equal patients suffering.
– Salim R. Rezaie, MD
The psychiatric crisis is another frustrating aspect of medicine in this country. Reimbursement for psychiatric care is lacking. Hospitals close psychiatric beds. Then care becomes scarcer. Even if patients do get a 72 hour admit to stabilize their condition, outpatient follow up is often unavailable. Psychiatric “care” then becomes a cycle of admission, discharge, emergency department, admission — which isn’t in anyone’s best interest. I’ve heard suggestions that discharged patients have the option to receive free bus tickets to state capitols. Wonder how that would play out in this case.
– William Sullivan, DO, JD
The author conflates psychological problems with psychiatric diagnoses, and quotes dubious statistics like “The percentage of people with serious mental illness in prisons rose from 0.7% in 1880 to 21% in 2005” (were prisoners filling out the PHQ-9 in 1880?). But one part I agree with is the quote from the EP: “We are the wrong site for these patients — Our crazy, chaotic environment is not a good place for them.”
– Nicholas Genes, MD, PhD
To add to what has already been stated, EDs are about the worst place to board these patients. If you weren’t suicidal at triage, there’s a more than decent chance you will be after 241 hours in your window-less, sterile ED room in a behavioral health wing with a sitter 24/7 waiting for your inpatient bed at the state hospital. Real numbers. This week.
– E. Paul DeKoning, MD, MS, FACEP, FAAEM
Federally qualified health center physician no longer believes in government health care
The gist of the article is kind of a non-sequitur. Paperwork, bureaucracy, and administrators with warped priorities — this is not unique to the author’s rural hospital, and not unique to facilities funded largely by the federal government. The rebuttal writes itself: “I am physician who spends hours on hold, trying to get authorization for tests and drugs my patients need — here’s why I no longer believe private insurance can work.”
– Nicholas Genes, MD, PhD
I tend to side with her. Full disclosure: I’m a less-is more kinda guy when it comes to government. Some of you will now stop reading, but I’ve never been convinced that government is the solution here. Or in most places, for that matter. Free-market competition that unleashes American ingenuity is best. Yes, certain degrees of regulation where needed. But, there is such a thing as too much. Enter the crazy hoop-jumping we all do every day (in lieu of actual patient care) when it comes to the Joint Commission, etc. God forbid I’m seen having a cup of coffee at my workstation on an overnight. As we often say at my house, “Don’t worry, I’m from the government. I’m here to help you.”
– E. Paul DeKoning, MD, MS, FACEP, FAAEM