Our college of medicine at Penn State is working with a small number of other medical schools to revise the curriculum so med students will learn to work as members of a healthcare team. In recent years, educators have begun to realize that we’ve been training doctors to be “lone wolves.” Then the new physicians enter practice and find themselves in an increasingly complex environment with multiple other healing professions. In the curriculum being developed, allied professions include nursing and pharmacy. Psychiatrists often work in teams—with psychologists, social workers, nurses, pharmacists, occupational and physical therapists, and many others.
I keep praying for universal access to health care for all Americans. It is essential that psychiatric care is included. But we don’t have enough psychiatrists (especially those qualified to see children and adolescents) as it is, and universal coverage could exacerbate the shortage. For me, the road to excellent universal mental health care will be based on efficient and cost-effective systems. (And no, I don’t mean asking exhausted clinicians to work faster and harder.)
Good clinical research can serve as a model. It is based on teamwork (beginning with the voice on the phone and face at the front desk). And it requires a protocol. Increasingly, electronics help—capturing data about history, target symptoms, and response to treatment; giving feedback to clinicians; enhancing communications between doctors and patients, family members, and other professionals; and supporting clinical decision making.
The teams we must build involve us with fellow professionals. But we also should include “Robbie the Robot”—i.e., information technology (and someday perhaps actual robots, which already are performing surgery). As psychiatrists, we can’t bring about this grand vision by ourselves, but we can and must have a “seat at the table” and participate in system redesign.