Dear (name),
I hope this finds you well and enjoying the beautiful Fall weather. All is well here in our new place in Battle Creek, Michigan. (See photos at the end.)
Although previous newsletters gave hints of what HAS MEDICINE LOST ITS MIND? is about, this one provides an overview of its main theme and its revolutionary direction. Many of the public will be unaware of the cause of the mental health crisis—and will be frightened to learn it. Primary care and other medical doctors conduct over 75% of all mental care, but they have not been trained for this role. That’s why they fail to recognize most diagnoses, and when they treat, it usually fails to meet minimum standards. Of course, it’s not their fault, they weren’t trained. One told me the other day why they need training, “There are no psychiatrists in my town.” (Psychiatrists and psychologists conduct only about 12% each of all US mental health care.) The obvious solution: train the clinicians who provide the care.
I and many others, including the Institute of Medicine, have produced compelling arguments and detailed instructions, supported by solid research, for taking this logical step. But to no avail. Medicine has not changed its training in mental health in over 100 years. It continues to provide no more than 2% of total training time across four years of medical school and several years of residency. Now consider that mental disorders are the most common health condition clinicians face in practice. How can this possibly be true: medicine fails to train its graduates for the most common problem they will face in practice! Has medicine lost its mind?
While on my last sabbatical, I contemplated medicine’s bizarre resistance to doing the obvious. Finally, after over 60 years in medicine, I realized that medicine wasn’t going to change. I shucked my plans to write yet another grant and decided to go outside medicine to the public with HAS MEDICINE LOST ITS MIND? My aim, like Ralph Nader’s Unsafe at Any Speed and Rachel Carson’s Silent Spring, is to enrage the public and, in turn, provoke political change. And it works. Nader’s book forced the government to form the National Traffic and Motor Safety Vehicle Act. This ensured the safety of previously dangerous automobiles (no seat belts, car went backwards when placed in drive), which the auto industry had ignored. Carson’s book led the feds to create the Environmental Protection Agency to ensure that the reluctant chemical industry kept DDT and other pollutants out of our drinking water. These experiences tell us that an enraged public can induce politicians to correct the harmful impact of institutions who refuse to place public interests foremost.
And I propose more than simply activating the public. I recommend the political way to proceed: that a Presidential or Congressional Commission evaluate the quality of scientific education conducted by all American medical schools. The commission would judge how well medical education meets the standards of all other sciences—a systems view of life. More specifically, they would determine how well modern medical education adheres to the biopsychosocial model, the specific systems view for medicine. Medical schools will be found grossly deficient. And the commission will recommend a massive change to full implementation of the biopsychosocial model. This would include vastly increased training in psychosocial material in all years of education, a significant part of which would be preparing all graduates to be as competent in mental health care as they are in disease care.
What do you think about this? Please send me some feedback!
Take care and be well!
Bob
PS—Photos of the front porch and from the porch looking onto Lake Goguac.