Marketing Psychiatry

by Maurice Rappaport, M.D. , Ph.D.

[Spring/Summer 1998; Vol. 25 No. 1]

Socio-economic forces are nibbling at the edges of medical practices, particularly those of psychiatric physicians. We must become more aggressive in marketing psychiatry.

The idea of marketing does not have a good ring to it. It smacks of the rough and tumble and sometimes undignified competition of the market place. Nevertheless, this is the scene in which we are now embroiled. To help not only psychiatric physicians but also people who need our services, we must engage the enemy. In this case, the enemy is the lack of information about what a psychiatric physician is and the unique things that he/she does. Many of these things cannot be done adequately by anyone else, particularly the many useful but limited non-physician mental health workers.

Unless we repeatedly place such messages before the public, two adverse developments are likely: (1) A decrease in quality mental health care and (2)unnecessary increases in cost. To prevent erosion of cost-effective care, psychiatric physicians and organized psychiatry must remain the primary advocates for good care. This means we must constantly develop strategies to help potential patients learn where to obtain the best care..

A continuous stream of brief public information messages must be launched presenting these 24 reasons why psychiatric physicians provide the best care. Hopefully, with the help of the American Psychiatric Association this can be a nationwide effort supported locally by all district branches as well as family-based and other organizations interested in promoting the best care for the mentally ill.

What is done best by psychiatric physicians that cannot be done by non-physician mental health workers? Here is a partial list:

1. Obtain and understand medical histories.
2. Review body systems for important physical complaints about which psychiatrists, as physicians, can make helpful recommendations.
3. Analyze, incorporate and integrate information from medical records into medically based psychiatric evaluations.
4. Establish primary and secondary medical diagnoses integrating physical and mental conditions.
5. Decide when it is necessary and appropriate to refer to other medical specialists.
6. Conduct medical inspections identifying important physical signs.
7. Conduct medical-psychiatric examinations identifying important symptoms.
8. Conduct initial neurological examinations.
9. Develop combined medical-psychiatric and psychosocial treatment plans.
10. Provide on-going medical support and reassurance to patients, family, and significant others.
11. Provide medication and timely medication adjustments.
12. Provide information on medication side effects.
13. Deal directly with adverse medication effects and emergency developments such as hypertension, hypotension, impact on thyroid, renal, liver and other systems affecting body functioning, neuroleptic malignant syndrome, cardiac arrhythmias, paralytic ileus, allergic reactions, anaphylactic reactions, extrapyramidal symptoms, convulsions, coma, imminent death, etc.
14. Provide information on interaction effects with non-psychiatric medications.
15. Provide on-going medical follow-up.
16. Order appropriate laboratory tests initially and periodically to monitor patient condition and minimize development of adverse effects of treatment.
17. Arrange somatic therapies when needed, including but not limited to electroconvulsive therapy.
18. Arrange medically supervised hospitalization with an attending psychiatric physician.
19. Consult with/about family on related medical/psychological matters.
20. Consult with primary care and physician specialists on a physician-to-physician basis.
21. Consult with human services workers on medical-psychosocial matters.
22. Complete necessary medical forms.
23. Prepare integrated medical/psychological summaries efficiently, timely and cost-effectively.
24. Provide close biopsychosocial follow-up care to detect and treat inevitable biopsychosocial changes that occur during the course of life.

This list, undoubtedly, can be amplified.

The goal is to place upper most in the mind of the public, particularly those who can benefit from psychiatric help, where to turn first to get the best care. The approach must be sufficiently vigorous and prolonged to override ill advised managed care and other health coverage restrictions. Those in need of good psychiatric care must be educated to demand such care.

Marketing psychiatry will not be easy or inexpensive. But let us at least emphasize the quality of care difference between services that can be provided by psychiatry compared to other useful but non-psychiatric mental health services.

Dr. Rappaport, a psychiatrist in private practice in San Jose, California, is immediate past president of the California Psychiatric Society. He uses his perspective as both an M.D. and a Ph.D. psychologist to provide perspectives on why prescribing by psychologists would not be in the best interests of patient care.