The Need for a Custom Job

Words Do Make the Game:

OK, now you'll get to know me a lot better. I love words. I love concepts. And most of all I love applied words, applied concepts. Check this out. Two fresh words for your consideration:

In these past posts you will notice that I keep slipping into different ways of thinking about the core of psychiatry, with new words previously reviewed like phenotypic, and endophenotypic. It's about changing the mind maps so we can change the territory. Soon everyone will be dropping these words on their friends at dinner on Saturday night. But for this moment they are still new.

If you read “public” commentary like Furious Seasons, and Depression Introspection you will quickly see that the public, the folks on the receiving end of things, wants to change the way “we” think about diagnosis and meds. The public has strong opinions about current medical trends.

These are two brand new words to encapsulate the problem. They are not in the big unabridged Webster's, so beware:

We are all commenting, all furious, on different levels, with this first word, the commoditization of psychiatry. “Commoditization” is on the money, the devaluation of things psychiatric. Others cover this point very well, so you can go over to Neuroeconomics to dig deeper.

Don't get me started on managed care and why psychiatry was the first medical subsystem to go down – or why it continues to be devalued. Psychiatry and medical practice has changed over time as a result of many forces, from pharmaceutical companies to the psychiatric gunslingers, the High Plains Drifters, of “managed” care. Bang you're dead. You once thought of suicide…? We will price you out of coverage, and will not support hospital care.

Money does talk, industrialization and dehumanization of psych practice is vigorously underway, and customization is calling to all of us.  We all want a good, personalized, custom job. We hate platitudes. We intuitively know we are more than a phenotypic diagnosis. [One day I will tell you real facts about the psychs that led the sell out to managed care -on the basis of “insufficient diagnosis.”]

Those psychs, as road agents, the hired guns of managed care, have been responsible for considerable pain as they have relentlessly diminished the psych intervention process with mangagebabble, and exploited the weaknesses present in the diagnostic system explored in these posts. Managed care groups cause far more pervasive harm than pharmaceuticals, yet with deep pockets and great PR, have dodged the media bullet. And their harm is covert not overt.

Insurance dependency brings a slow death. Remember, don't submit the [APO E4] test to your insurance company for Alzheimer's. Get up on that stealth radar…BAM! – you are gone. Who knew?

Pharmaceutical problems are acute, like a fender bender in the rain. Front page news. Wow.

So what are we dealing with in our offices and our lives? How do the economic forces compel the  uninformed…the phenotypic managebabble dreamers. The economics crowd [no matter their training, from academia to health insurance] wish for, they ask for, they do require: the homogenization of psychiatry. Remember: good research controls out the differences for the best results.

Homogenization is the process of breaking up the fat globules in cream to such a small size that they remain suspended evenly in the milk rather than separating out and floating to the surface – the cream does not rise to the top….

So what we're dealing with folks is simple: we, out here in the real world, want cream, we don't want homogenization. Details in the office are relevant. We resent the antiscientific “research” trend associated with industrialization and the dehumanization of the practice that should be most humanized: correcting individual problems.

Try “commoditization” and “homogenization” on your friends. I'll bet they'll listen and agree, even if they don't know what you're talking about.

Whew. Hang in there team, not so heavy on the words next post.