Communication Commentary: Time in a Bottle: The Psychopharmacologist-Patient Relationship in “Split-Treatment” Models of Care

Abstract

The doctor-patient relationship has been and remains the keystone of all medical care. It is the medium by which symptom data are gathered, diagnosesmade, thepatient is engaged in the enterprise of formulating a treatment plan, the issues of motivation and adherence are addressed, and nonjudgmental support is provided to enhance the work of healing (1). Medical communications researchers Roter and Hall (2) remarked that “talk is the main ingredient in medical care and it is the fundamental instrument by which therapeutic goals are achieved” (p. 8). They noted that we in the psychiatry field are “participating in a dramatic transformation of the identity of our profession. Clinical practice is moving toward psychopharmacological evaluation and treatment monitoring as the principal role for psychiatrists in direct service provision” (p. 13). Psychiatrists often work in teams with nonphysician therapists, casemanagers, andother specialists. This model can be very effective for individualizing care such that patients may receive appropriate multidisciplinary treatment from professionals with high levels of expertise in their areas of specialization. Access to psychiatric care is often limited. A collaborative care team or “split-treatment” model in which nonphysicians provide psychotherapy and/or other psychosocial interventions and physicians provide psychiatric assessment and psychopharmacological care allows greater psychiatric access for patients in need. In fact, Interian and colleagues