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Physicians in all practice settings face tremendous pressure to “do something” to help their patients. All too often they face severe systemic barriers to doing so. In low-resource communities in most countries of the Western world, including urban, rural, and frontier settings, psychiatry appointment time is often limited. Because primary care physicians prescribe an enormous amount of psychotropic medications—more, in absolute terms, than do psychiatrists in the United States—patients who are referred to psychiatrists may be especially resistant to first-line therapeutics. With shortages of psychiatrists, tremendous clinical need, and limited access to care resources, a typical initial psychiatric consultation may be very brief, and some patients may wait 3–4 months just to have that initial evaluation.
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