It is not clear whether these are features of the disorder itself, artifacts of sampling bias, or consequences of being identified as a sex offender.
Primary Psychiatry May 21, Dr.
Bursztajn is associate clinical professor of psychiatry and Mr. The authors thank A. The authors report no financial, academic, or other support of this work. Abstract How does managed care contribute to the psychiatric hazards of medical illness?
How can primary care physicians and psychiatrists as treaters or consultants recognize and manage the clinical dynamics that result, together with their liability implications? For patients in managed healthcare settings, a latent subjective sense of captivity triggered by care restrictions can exacerbate feelings of helplessness and hopelessness brought on by the threat of serious illness.
In the extreme, some patients will experience the escalating distress characteristic of posttraumatic stress disorder. The introductory, ongoing, and termination phases of the treatment alliance are analyzed as focal points for particular clinical interventions.
In this atmosphere, patients and their physicians—who face the threat or actuality of a major illness—may experience heightened feelings of helplessness and hopelessness, especially when healthcare benefits are denied. In this atmosphere, physicians often avoid consideration of treatment alternatives they view as likely to be denied by a managed care reviewer, or feel compelled to focus on the catastrophic possibility in the differential diagnosis to obtain otherwise denied benefits.
The sense of virtual clinical captivity that patients and physicians can experience in the face of benefit denial need not be taken as a fait accompli. By becoming aware of the dynamics and dilemmas of the physician-patient relationship under managed care, treating physicians can create greater freedom for their patients and themselves to work together effectively.
Useful clinical interventions can be implemented to recover a sense of choice in the doctor-patient relationship, while decreasing liability risk, by effectively anticipating, preparing for, identifying, and responding to the distress that is likely to accompany managed care restriction of clinical care.
There are compelling clinical and ethical considerations favoring a proactive stance by physicians who are aware of potential negative managed care influences on their patients. Given that helplessness and hopelessness have been documented to be predictors of negative patient outcomes eg, in breast cancer ,5 the undermining of the clinical process and the resulting loss of trust also undermine the potential for healing relationships and, in turn, the likelihood of positive health outcomes.
Physicians who work to reverse this process are not just protecting themselves from liability, but also providing quality care by protecting patients from the consequences of helplessness, hopelessness, and distrust. Serious illness can heighten dependency while bringing with it feelings of helplessness, hopelessness, and distrust associated with depression.
When faced first with a lack of choice of a provider, and then with restriction or even denial of care, the vulnerable patient, already feeling like a prisoner of the threat of serious illness, may now also begin to feel like a lonely captive of the healthcare system.
What care will I receive? The resulting anxiety and depression can lead to a greater likelihood of dissatisfaction with medical care9 and to an impaired capacity to act on that dissatisfaction by changing health plans.
Often, the treating physician may not have freely chosen to be part of a particular managed care organization MCO nor to treat a particular patient, except as the best of a set of undesirable choices or the lesser of necessary evils. The physician is also likely to have experienced a substantial reduction of economic and professional autonomy in the shift to managed care.
Like the patient, the physician may have few options and insufficient time to recognize, reflect upon, process, and put into perspective the feelings engendered by the managed healthcare context.The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment.
Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. A native of Providence, RI, Aaron T. Beck had an interest in the vagaries of human nature as far back as he can remember.
After graduating magna cum laude from Brown University in , he embarked on a career in medicine at Yale Medical School, graduating in Psychopathy, from psych (soul or mind) and pathy (suffering or disease), was coined by German psychiatrists in the 19th century and originally just meant what would today be called mental disorder, the study of which is still known as vetconnexx.com the turn of the century 'psychopathic inferiority' referred to the type of mental disorder that might now be termed personality disorder.
Abstract. Generalized anxiety disorder (GAD) is characterized by excessive anxiety and worry occurring over the course of ≥6 months. GAD has a % lifetime prevalence in the general adult population, and an 8% lifetime prevalance in the primary care setting. Major depressive disorder has significant potential morbidity and mortality, contributing to suicide (see the image below), incidence and adverse outcomes of medical illness, disruption in interpersonal relationships, substance abuse, and lost work time.
With appropriate treatment, % of individuals with major depressive disorder can achi. Abstract. Generalized anxiety disorder (GAD) is characterized by excessive anxiety and worry occurring over the course of ≥6 months. GAD has a % lifetime prevalence in the general adult population, and an 8% lifetime prevalance in the primary care setting.