The progress and prospects of psychiatry

Article Abstract:

A report in the November 21, 1990 issue of JAMA, The Journal of the American Medical Association on the future of psychiatry indicates that its future is bright, indeed. The major trends during the last 20 years have included: (1) establishing psychiatry as a definitive medical specialty; (2) moving away from ideological argument to empirical evaluation of treatment efficacy; (3) increasing the scientific database; and (4) removing the stigma often attached to psychiatric illness. A brief history of psychiatry in the US is presented. Two other articles in the same issue address the importance of recognizing the widespread nature of mental illness. One study found that the rates of other mental disorders for people with alcohol or other drug abuse disorders were 37 and 53 percent, respectively. Thus, treatment of mental illness should be a focus of drug abuse prevention. The other study found that both major depression and depressive symptoms contribute heavily to disability days and days missed from work. Although psychiatry is an exciting specialty, four main challenges can be cited that it must confront. These include improvement of the rate of insurance coverage for psychiatric illnesses, and extension of payment to poor people so they can receive quality psychiatric care. The uniqueness of some of psychiatry's areas of specialization must be preserved; for instance, the idea that psychologists might be allowed to prescribe drugs for patients threatens the quality of care. Research funding that utilizes recent advances in brain imaging techniques and neurobiology needs to be increased. Finally, better understanding of the psychosocial factors that contribute to mental illness should be pursued. Psychiatrists, because of their careful attention to each patient's individuality, are in an excellent position to evaluate and promote better patient-physician relationships. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Psychiatry, editorial

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The patient-physician relationship: JAMA focuses on the center of medicine

Article Abstract:

The new concept of patient-centered medicine may help improve the physician-patient relationship. Patient-centered medicine focuses on a better understanding of the patient's wishes. The physician-patient relationship has been tarnished by the rise of technology and managed care. Technology encourages doctors to rely on a battery of diagnostic tests at the expense of a careful history and physical exam. Managed care damages the physician-patient relationship because it encourages doctors to cut costs and spend less time with their patients. In addition, the focus on the biology of disease neglects the emotional and social aspects of disease. Patient-centered medicine should improve the physician-patient relationship because it will require doctors to listen to their patients and will restore patients' trust in their doctors.

Social aspects, Medical care, Physician and patient, Physician-patient relations

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Informed consent for publication

Article Abstract:

The standards for protecting a patient's right to privacy promoted by the International Committee of Medical Journal Editors have been criticized. These guidelines require that all personal information that would identify patients in a clinical trial be removed from a paper before publication. A public health scientist believes that this undermines the rights of society to obtain accurate information about communicable diseases. The 50th anniversary of the Nuremberg trials has focused attention on informed consent in medical research.

Standards, Medical publishing, Informed consent (Medical law), Informed consent

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