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Kaiser Settles Suit

While reading about the outcome of Dr. Thomas Jensen’s suit against Kaiser Permanente’s San Diego HMO in the October 6 issue, I was painfully reminded just how far the collective mentality of psychiatry has plunged into a managed care paradigm of minimalism.

Dr. Jensen protested the policy of the HMO that "required" psychiatrists to prescribe without personal examination of a patient. Physicians who participate in such a practice do not have the HMO policy to blame, but the outcry suggested that the policy was responsible for physicians’ not performing their required duty.

This is another example of "The devil made me do it" phenomenon, much like "The insurance company made me discharge the patient after two days." If managed mental health care has driven psychiatric practice into the ground, it has been with the hands of psychiatrists planted firmly on the wheel. If we would just look to ourselves and each other to set the standards, HMO practice policies would not even be in the realm of relevance. I am glad this physician took the position he did, but the fact that he needed to take it in the first place is discouraging.

The new policy at Kaiser, heralded as an innovative coup for psychiatry, is that physicians are going to have to actually examine patients before prescribing medication for them. Most of us guess this will in many cases amount to a brief introduction, handshake, and five-minute "examination" with prescription passing along the way. The absolute minimum standard has now been voiced as something to be proud of, an achievement of sorts. Have we gone that far down?

Douglas Beech, M.D.
Columbus, Ohio 

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