by Gerald D. Klee, MD, Editor
[Fall 1997; Vol.24 No. 3]
You’ve probably noticed that the world is changing at an accelerated rate—especially health care services. Psychiatric practice has changed dramatically in only a few years, and this is only the beginning. Although the basic sciences underlying the practice of psychiatry continue to develop, these are not the primary forces responsible for the huge changes taking place. Economics, demographics, and politics are the driving forces. Added to this is information technology, involving such things as computers, satellites, and fiber optics, which link the world together as a global village. These systems are used for many purposes, both good and bad. Among the good is the new MPS World Wide Web site.
In this and upcoming issues, The Maryland Psychiatrist plans to focus primarily on changes taking place in psychiatry in Maryland. A well-informed membership will be best able to help shape the momentous changes that affect our patients and our profession.
Managed care and information technology impact strongly on medical ethics. With her article on Ethics and Capitation, Marianne Benkert begins a series on this subject.
Psychiatric residency training is strongly affected by managed care. Walter Weintraub contributes the first of a series of articles on this subject. Managed care is the major force leading to the recent merger of the psychiatric residency programs of Sheppard Pratt and the University of Maryland Psychiatric Institute. Donald Ross, who is quoted in this issue, has summed this up in “Changes at Sheppard Pratt.”
A knowledge of information technology, especially computers, is becoming essential for the survival of psychiatrists, individually and collectively. Many of us have tried to hide from this technology, hoping we’d retire before having to deal with it. No such luck. It’s here. In fact, it’s almost everywhere.
Even if you don’t use a computer, your name and credentials are on the Web. Many data banks out there contain information on you and on your patients—stuff you didn’t even know is being collected (let’s hope it’s all well encrypted!). Computerized patient records and clinical practice guidelines are nothing new. Methods for diagnosing and treating patients by computer are also in use. There are numerous Web sites offering the services of cyberpsychotherapists.
Telemedicine is booming. It can be a blessing, bringing high-quality health care to remote areas without the necessity for the doctor and patient to meet each other. But imagine the potential for harm, especially if telepsychiatry is combined with managed care. Think of the profits ruthless people could squeeze out of the system. How will telepsychiatry affect your practice?
We don’t know how many Maryland psychiatrists use computers, but it’s our impression that physicians in general and psychiatrists in particular lag behind people in the “hard” sciences in computer literacy. Younger physicians are far ahead of older ones.
What, if anything, would you like to learn about computers and information technology? MPS now has a Computers in Psychiatry Committee co-chaired by a husband and wife team, Glenn Brynes and Carol Watkins. See their article, “Starting Out with Computers,” on page 6 [this article is not in the online archive]. You can’t escape the Web, so let the committee help you use it. You can also learn a lot from the APA, Med Chi and other sources. Ensure a future for your patients and yourself. Get online. Help make information technology improve rather than dehumanize patient care.