You may have seen Lady Gaga's recent interview with Oprah Winfrey where the singer and actress opened up about her struggles with mental health and how beneficial appropriate psychiatric care had been for her.
If you haven't yet seen it, her overall comments were commendable. It is powerful to hear a public figure destigmatize mental health treatment so openly. Unfortunately, she also took a heated detour about how primary care physicians should not prescribe antidepressants and suggested that all mental health care services should be performed by psychiatrists. These misguided ideas were echoed in a recent opinion piece in The New York Times that suggested primary care physicians have "no psychological, psychiatric or psychopharmacological training at all."
(That misinformation was compounded by the fact that the writer based his unfounded claims about U.S. health care on data collected in France eight years ago. The apples-to-oranges nature of the information was lost on any reader who didn't click through to the source material.)
It's disheartening to hear these opinions from high-profile sources. I will be the first to say that in complex, multifactorial cases, I should not be (and am not) the physician in charge of a patient's psychiatric care. However, behavior change, psychological care and psychiatric care are significant parts of my practice and are well within my scope as a primary care physician.
As the AAFP said in its response to Lady Gaga's statements, family physicians "receive extensive training in caring for patients with depression and mental illness."
Nationally, primary care physicians are often the only access point to care for patients experiencing depression, anxiety and even more serious disorders such as psychosis or schizophrenia, especially in underserved urban and rural areas. We fill an important gap created by the shortage of psychiatrists in this country, and the Academy fights to ensure that we're paid properly for providing mental health services because it is such a large part of what we do.
In fact, the American Psychiatric Association champions a collaborative care model headed by primary care because of the overwhelming evidence that it works.
I work in a practice that is impressively integrated with our mental/behavioral health department. We have a number of mental health clinicians on staff and a wonderfully knowledgeable psychiatrist, and we confidently screen all patients for depression and anxiety knowing that we can provide interventions if needed. Through my practice, I've developed an understanding of psychiatric medication and can skillfully select, trial and monitor medication if needed. So, when a patient comes in at their wits' end from months of anxious thoughts playing like a screensaver in their head, I have the tools and comfort level needed to treat the patient's anxiety in a multimodal, holistic manner.
To say that I "should not" prescribe medications I have been trained to prescribe actually fragments our health care system further, makes access to appropriate psychiatric care more difficult and implies nothing more than a referral clerk role for physicians who have many years of experience and training.
Instead, we could intentionally integrate our health care system with more robust clinical support for comprehensivists like family physicians throughout the country. Who knows? Increasing access to quality psychiatric care at the primary care level may even serve to further destigmatize mental health.
Lalita Abhyankar, M.D., M.H.S., is a family physician practicing in New York City. You can follow her on Twitter @L_Abhyankar.
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