Beyond “Med Management”

Language matters because it frames everyone’s conception of an activity and sets the stage for what happens. The names “medication clinic” and “psychopharmacology clinic” came about to distinguish these clinics from the practice of pure psychiatric psychotherapy, a distinction that is no longer needed. The core problem with the name “medication clinic” is that it places the emphasis on medications when the emphasis should be on care. The work of outpatient psychiatric care providers is to engage, evaluate, formulate, educate, and partner with the service user to design and act on a plan of psychosocial, educational, and somatic interventions to support recovery (7). The clinical encounter is an active human process that often includes but is not limited to prescribing medications.

We recommend using the term “psychiatric care” to describe the function, “psychiatric care clinic” to describe the work activity, and “psychiatric care provider” (rather than the reductionist term “prescriber”) to describe psychiatrists, psychiatric nurse practitioners, and psychiatric physician assistants together. These terms parallel “primary care,” “primary care clinic,” and “primary care provider.” Calling the work “psychiatric care” emphasizes the act of caring. The term also respects the complexity and humanity of the work. Psychiatric care (like primary care) does not equal prescribing even when it includes prescribing.

In addition, to leverage the skills and energy of a limited psychiatric workforce, psychiatric professionals must redesign the workflow of the psychiatric care visit to enhance its health-promoting capacity. The redesigned visit might look more like a smooth-running primary care office where history taking, basic assessment, and measurements of vital signs are gathered before the physician enters the room and where designated team members are prepared to put the treatment plan into action at the end of the visit. For example, core required data (the patient’s aim for the visit, symptom ratings, side effect concerns, and use of medication and other substances) can be collected by a trained psychiatric medical assistant or a good computer program. Common clinical scenarios can be anticipated, allowing psychiatric care clinicians to design effective and efficient clinical pathways—organized packages of screening, measurement, education, and therapeutic intervention (including but not limited to medications) that can be ordered with the check of a box when indicated. Pathway development organizes the work before the patient enters the room so that time-constrained psychiatric care providers can efficiently acquire needed assessment information and initiate complex, thoughtful plans that meet patient needs. With well-designed workflows, psychiatric care providers can use their limited time for the essential health-promoting work: connecting therapeutically, integrating patient-specific aggregated data with what is known from the scientific literature, and partnering with each patient to develop a practical shared bio-psycho-social plan.

Designing more efficient, effective, recovery-promoting care requires the expertise of systems engineers, people with the lived experience of mental illness, experienced psychiatric care providers, computer programmers, educational experts, and others all working together as a team. New workflows that do not make the care better for patients and easier for psychiatric care providers will not be implemented and used in routine practice. This future workflow redesign will build off past and current efforts to use measurement in standard care (8,9) and to make the care process more recovery oriented (10).