When Health Reform Is Discussed, APA Will Be There, Stotland Vows

APA can shape its future and the future of health care.

That's the message APA's incoming president, Nada Stotland, M.D., wants to send to members as she begins her term, succeeding Carolyn Robinowitz, M.D. (see Citing Importance of Advocacy, Robinowitz Urges, 'Just Do It').

In an address at last month's annual meeting in Washington, D.C., Stotland vowed to involve APA in discussions about the shape of the American health care system and to help educate psychiatrists about the options for health system reform.

“The November elections offer us a major opportunity to shape our future,” she said. “We spend more per capita on health care than any other country in the world, without producing more health.

“What are we doing wrong? Health care costs go up, increasing the number of uninsured who don't seek care until their problems are catastrophic,” Stotland said. “Our emergency rooms are clogged with patients for whom there are no resources. Our jails and prisons hold more people with mental illnesses than our hospitals. We have to fill Congress and the White House with people who will do something about that.”

She said APA will provide information—in Psychiatric News, on the APA Web site, and at scientific meetings—to educate APA members about the advantages and disadvantages of different health care reform proposals.

At APA's Institute on Psychiatric Services in October in Chicago, there will be a debate between advocates for a single-payer national health insurance system and the system of tax credits and insurance subsidies advocated by the AMA, Stotland said.

“Which kind of health care system will offer the future we want: a system that doesn't force us to ask about insurance coverage before we ask about symptoms, a system that doesn't discriminate against our patients, a system that respects their privacy, a system that pays us fairly and promptly, a system that spends our money not on obstacles to medical care, but on medical care.”

Stotland echoed her predecessor's emphasis on the need for advocacy by psychiatrists. “I know what it's like to feel intimidated about speaking to legislators and the public,” she said. “But if we don't provide mental health information, somebody else will.”

She earned a round of applause with her insistence that advocacy be based on the value of patient-centered care.

“You may have taken it for granted that I said 'patients,' ” she said. “Some of our patients want to be called 'consumers.' I think I understand why. But a consumer buys a product or service from a seller who acts in her own interest; a physician acts in the interest of her patient. A seller closes the shop and goes home for the day; a physician is responsible for a patient 24 hours a day. A seller is not trusted with a buyer's most intimate secrets and feelings or expected to keep a buyer's confidence.

“Those are sacred obligations,” Stotland declared. “When I am sick, I want to be my doctor's patient.”

Stotland also warned that the future that APA hopes to shape will be fraught with challenges and dangers.

“Our future is going to include some things we have doubts about, like so-called 'pay for performance,' ” Stotland said, referring to the trend in public and private payer systems of matching reimbursement with success at meeting quality measurements.

“There are few aspects of medical 'performance' that are both measurable and meaningful,” she said. “But the idea of paying for performance has a strong appeal to the public. I think APA has made the right decision under the circumstances—to sit at the table with our colleagues in other specialties and develop standards to shape the future of pay for performance, demanding evidence-based criteria and the flexibility to adapt our care to the needs of individual patients.”

Stotland said efforts by psychologists to prescribe medication through legislative changes will continue to challenge APA. “We have lost a couple of fights with them, but we have won and will win many more,” she said.

And Scientology, she said, will continue to be a threat. “Scientology is...an organization determined to destroy us,” she said. “It influences our legislatures, our FDA, our schools, and our media as a moving force behind the unwarranted black-box warnings that discourage people from taking treatments they need....Our strongest defense is a public armed with accurate information about psychiatry and Scientology.”

Stotland closed by saying that social and political issues—abortion, gay rights, and interrogation of detainees in the war on terror—will also continue to engage psychiatry.

“There is no credible evidence that abortion causes psychiatric illness,” she said. “But while we spend years developing a scientific basis for psychiatric diagnosis, a so-called 'abortion trauma syndrome' has been invented to frighten patients and influence legislatures and judges. We have to provide the facts so that our patients can make decisions based on their own values.”

She concluded with a vigorous reinforcement of APA's stance on participation of psychiatrists in interrogations. “We are healers, not inquisitors,” she said. “Under the leadership of past President Steven Sharfstein, we led the medical and mental health professions with a crystal-clear policy—we will not participate in those interrogations.

“We can shape a future in which we do well by doing good,” Stotland said. “In the end, we will not be defined by what legislators do or don't allow others to do. We are defined by what only we can do.” ▪