Candidate for President-Elect

Act always in the best interests of our patients. This maxim is the solid foundation for all we do in psychiatry. It is cited so often, it has become a truism, taken up even by those who have no real commitment to the welfare of patients. Now is the time for all of us to step back and look at the forces that push us to practice in ways that we know are less than the best we can do. There are many of them: pressures to curtail care in general, commands to use certain treatments instead of others, and color-by-number treatment protocols and checklists that make it seem as if diagnosing and treating mental disorders is simple. But practicing psychiatry is not simple.

The burden of mental illness is so huge that we psychiatrists are far too few to manage it. We simply have to have help from others. We are collectively proud of our good relations with our colleagues engaged in the same mission of helping. But we have sometimes allowed it to appear that there is really not all that much to psychiatry. We have allowed it to appear that anyone with a checklist and a prescription pad can do it well. We know better. It is time that we firmly and repeatedly say so. There is simply no substitute for a psychiatrist with excellent training who comes to the field, and to each individual case, with a deep capacity for understanding and fostering the doctor-patient relationship.

We must take public pride in the remarkable body of knowledge and skill we as psychiatrists bring to the treatment of individuals who are suffering. We must affirm that we have special skills that are rare and valuable. This means that we must be very careful when working with nonpsychiatrist physicians to be completely collegial and respectful of their skills, but not to ever accept the idea that everyone can treat mental disorders equally well. This means that when treatment algorithms are proposed, we need to learn what we can from them, but not allow them to be imposed in ways that contradict our best judgment for an individual patient.

As your senior APA vice president, busy clinician, and psycho-oncologist at the University of Michigan Comprehensive Cancer Center, I understand the clinical issues we face every day as we try to do our best for our patients: privacy intrusions; managed care nightmares; lack of national mental health parity; psychologists who want undeserved prescribing privileges obtained from legislators, not medical schools; and membership problems within our organization.

These are difficult times for psychiatry and for our patients. Difficult times demand strong leaders. I am committed to meeting the challenges to psychiatry and working with you to uphold the highest standards of our profession. Our patients deserve no less.