Dinah Miller M.D.

Shrink Rap Today


Systematic Psychiatric Evaluation: Take Your Time!

Psychiatric evaluation is more than a checklist of symptoms.

Posted Oct 24, 2012

Psychiatry is an evolving field, and from the time when I started training, the emphasis has shifted to seeing more patients more quickly, or so they say. The demand for care is greater than the demand, and insurers pay better if the doctor sees more patients for medications, and leaves therapy to less expensive professionals (I hate the term "provider," but not nearly as much as I hate the term "consumer").

So far, in my own practice, I've resisted the forces that call for conveyer-belt care and check-list diagnoses, and so it was refreshing to read Systematic Psychiatric Evaluation, by Drs. Margaret Chisholm and Constantine Lyketsos, on formulating psychiatric problems based on The Four Perspectives of Psychiatry (McHugh & Slavney, 2nd edition, 1998). Nothing about this method of psychiatric evaluation calls for cutting corners, or doing anything other than thoughtful and comprehensive evaluation of patients, while considering their circumstances from the perspectives of disease, motivated behaviors, personal temperament, and the individual's life story. For those who would replace the psychiatrist with a checklist of symptoms, diagnosis by "meeting criteria," and treatment based on insurance company formularies, this book is not for you. If, however, you're a clinician interested in taking care of patients in a meaningful way, this is a great guide to thoughtful care evaluation. Warning: there are no DSM lists or reference.

I wrote a more complete review over on Clinical Psychiatry News, and the book's first author, Dr. Chisolm, wrote a guest post talking about why she wrote it over on our main Shrink Rap blog.