Mental health diagnosis makes parity impossible

Last week I described new efforts to give mental health parity with physical health in insurance plans.

As a long-time mental health consumer, the report was both gratifying and annoying. That's because, as many in the profession know, mental health professionals treat what they do as an art, not science.

Now a Rhode Island study shows this extends to actual diagnoses, not just treatment.

Mark Zimmerman (right) handed out questionnaires at medical conferences on depression. They asked whether the respondents were using the standard Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) in diagnosing major depression.

The DSM-IV is standard stuff, and its criteria for major depression is decades-old.

This should have been a no-brainer. It's like asking programmers whether they systematically debug their programs, or Toyota repairmen whether they check recall notices.

A quarter of the psychiatrists surveyed said they used the DSM-IV less than half the time in making this crucial diagnosis, the one for which medications like Prozac are now called for. And two-thirds of the non-psychiatrist physicians were ignoring the book more than half the time.

In his paper at the Journal of Clinical Psychiatry, Dr. Zimmerman suggests that, in updating the DSM, clinical utility needs to be considered. He suggests shortening the criteria so it won't tax the poor docs' brains.

That's a good idea. It's always good to simplify things. How about if we change the name of the next DSM to "Psychiatry for Dummies?"

But there's a simpler question that needs an answer.

How are you diagnosing major depression, doc? By guess and by gosh? Are you reading chicken entrails?

How can anyone claim to be a doctor when they ignore the standard diagnostic criteria and basically just do what they want? How are insurers (or worse, me) supposed to pay you for your work when you ignore the procedures for diagnosis and treatment?

Hey, how about this. Next time you go to the heart doctor, he'll just listen to your chest and, if he feels like it, give you nitroglycerin tablets. How about that?

Sorry to be so angry here, but I have always supported the profession, and believe strongly that mental health concerns are just as disabling as physical concerns, just as deserving of professional treatment.

But how can anyone support that position if psychiatrists insist on acting like witch doctors, diagnosing problems by the seat of their pants, and ignoring the science that disagrees with their own treatment preferences?

Please use the thread that follows to describe your own psychiatry horror stories.

This post was originally published on Smartplanet.com