Posted by alexandra_k on January 2, 2015, at 14:18:27
In reply to Re: psychiatry is an ougrowth of society » alexandra_k, posted by herpills on January 2, 2015, at 10:06:28
> I think a big part of the problem, at least from my experience and perspective, especially in community mental health, is that clinicians spend so much time "assessing" instead of simply listening to the patient and what their particular needs are, and then providing that service to the patient.
I think that part of the focus on assessing is giving junior docs practice assessing / something to do.
I think that the other part of the focus on assessing is that it is necessary for access to the $$$. Insurance companies and community mental health have strict rules on what treatments they will and will not fund and all of this is determined by the diagnosis that the patient has. Hence... Attempts to (fairly creatively, sometimes) recast the patients troubles in... More lucrative directions. If you are lucky enough to get a clinician who feels like going in to bat for you, anyway. They do have to be careful of being too creative or their managers / the insurance companies will start giving them grief.
If the insurance companies / the government management people aren't running the show then... If you are paying your doctor then... Your doctor has freedom to WORK FOR YOU. If the insurance companies or the government is funding the treatment then, well, lets not kid ourselves as to who is running the show. Remember Madmen how the guy phones the psychiatrist to talk about how treatment is progressing with his wife? The psychiatrist tell him... Makes recommendations to him... Lets not forget who is paying for what. Who people are working for.
> This is one reason why I'm tired of hearing people complain about "Obamacare" or "socialized medicine". The fact is, no matter what healthcare system we have in place...the more money you have, the more options you will have, which means the better chance of receiving quality care.
Yes. I think the idea of socialised medicine... Is an idea best applied to things like... If you get hit by a bus and you need emergency trauma surgery. The idea that you get that emergency care without being left with crippling debt. Or if you have a heart attack and you need a bypass. You get that without crippling debt, too. Not the idea that everyone who wants intensive psychotherapy for anxiety gets to have that intensive psychotherapy. Mostly because... We simply can't afford it. But then people get all upset about how 'mental illness is real - too!' and so on... But there isn't enough money...
Only... I really don't see how there isn't a bunch more money then we think there is. I mean... How much money did it cost for this or that government department to change their name and change the letterhead on all their stationary? How much money did it cost for them to research, come up with, implement a policy that moving people from the main waiting room to smaller rooms out back (thereby reducing waiting room times by half)? How much money does it cost them to have government workers sitting on $80,000? Flying business class on short notice in tiny (practically charter planes) between towns that are only, like, 4 hour drive... How much money do managers make (what bonus do they get) when they cook up some hare brained scheme to enable politicians to intentionally mislead the public about 'improvements' to 'intermediate performance measures' (meaningless ones like 'access to healthcare when a bunch of people don't trust it for obvious reasons, don't want a bar of it, and CHOOSE not to use it because of that)...
The problem is:
It is so easy to criticise. So very much harder to come up with helpful, practical changes.
So very much harder to get those practical changes to happen. People... There is some kind of attitude... Some kind of... Victim blaming of those who suffer the most. For sure. Like this idea of 'equal opportunity' which works out great so long as the impoverished classes were offered a bunch of things that weren't helpful... So then when they fail (as they were set up to) everyone alike gets to uniformly believe (but not say aloud) that they must be stupid... It certainly gets people stopping with proclaiming that a certain class is being intentionally kept down / that opportunities are being barred from them... We say we want impoverished classes to be healthy... But secretly... I think a bunch of people get a kick out of feeling 'better than' that you got people (who clearly aren't malnourished) suffering obesity and diabetes and so on... Helps people feel that the status quo (heredity, wealth inner circle) is in fact justified after all.
poster:alexandra_k
thread:1074584
URL: http://www.dr-bob.org/babble/social/20141123/msgs/1074729.html