February 28, 2008 The success of any enterprise is based upon several factors some known some unknown. Psychiatry is one of these fields with few known and a large number of unknown factors. Its practitioners struggle with this and adapt their methods to the state of current knowledge or engage in various explanations to justify their practice. Author’s experience of three decades in the field of psychiatry have encompassed a journey in various settings from academic, private practice, community mental health, state hospitals, Veterans administration, Indian mental health, Forensic setting, HCFA surveyor, medical director and different parts of the country from New York to Florida, Louisiana to California have led to certain conclusions that are presented in this monograph.
The quality of psychiatric care remains uneven despite tremendous advances over the years. The developments in research have failed to translate changes in actual practice. Diagnosis are made often by a personal bias despite specific criteria and treatment shows little adherence to published clinical guidelines. The advances in computerization have benefited most industries but health care has failed to capture its ability to easily and quickly gather data and subject it to analysis. Computerization has added considerable efficiency and rise in productivity in most industries. How does one translate this to the field of psychiatry? Author at first devised programs to make the diagnostic process quicker, easier and uniform. The second series of programs was written to simplify the pharmacological treatment by providing easy access to guidelines. This monograph is an attempt to add the ability to analyze data, i.e., introduces Metrics. Metrics refers to the ability to measure data and analyze it. Numerous research instruments have been devised to measure and quantify the change in patient’s symptoms for drug research. These same instruments can also be used by the average practitioner to perform his own analysis on the data of his own pool of patients.
Metrics can be applied to measure interventions’ effectiveness and administration of inpatient and outpatient settings. The following chapters spell out this process with examples, case studies and references. This monograph is divided into 2 halves. “Metrics in Psychiatry”, gives a brief history of psychiatry of last 3 decades, Fads and fashions in psychiatry, What works examines the question in depth and lays out the principles of good practice. This is followed by examples in outpatient and inpatient settings. The second half “Art of Psychiatry” examines the practice of psychotherapy in outpatient, inpatient, child and adult settings. It examines concepts of therapeutic alliance, transference, therapeutic milieu and therapeutic community. Different models from personal psychology are explored along with their application in various settings. A Critique of unacceptable therapy is included. The reasons things go wrong in inpatient settings from child, adolescent and adult settings is examined and solutions are suggested. Case studies show the application of these ideas in practice. Art of psychopharmacology shows a critical evaluation of various styles along with a discussion of Polypharmacy. The often neglected subject of psychiatric administration is presented with a theoretical model along with a way to examine the process of change in dysfunctional institutions.
This monograph is likely to be useful to Mental Health Professionals who have been in practice for a few years. They have seen the problems explored here and may find a new way of addressing those issues. The necessity of an appropriate theoretical model, uniform practices, collecting objective data and subjecting it to analysis is emphasized. Links in ‘purple’ can be clicked to go to the suggested articles directly from with in this e-book.
Author sincerely hopes that this will launch a dialog that involves everyday practitioners in a concerted effort to bring empirical evidence into actual practice. Comments can be posted on this blog.
March 13, 2008 