StudioTulsa on Health: "Should Mental Health Be a Primary-Care Doctor's Job?"

Oct 31, 2013

On this edition of StudioTulsa on Health, guest host John Henning Schumann speaks Dr. Suzanne Koven, who practices internal medicine Massachusetts General Hospital in Boston, and who also writes the "In Practice" column for The Boston Globe. Earlier this month, Dr. Koven published an article at The New Yorker Magazine's website entitled "Should Mental Health Be a Primary-Care Doctor's Job?" (which can be accessed here). It's an engaging, well-written essay that explores some fundamental yet little-discussed questions about the work that primary care docs actually do in this country today, and it begins like so: "Patients occasionally ask me if I'll be the doctor who'll take out a gallbladder or deliver a baby. I tell them, 'You deserve better.' I'm a primary-care internist, and my expertise is broader than it is deep. I manage high blood pressure and cholesterol but refer people with heart attacks to cardiologists; I perform Pap tests and prescribe birth-control pills but send pregnant women to obstetricians.... With mental illness, though, the limits of my role are less clear. I'm comfortable helping people get through life's more common emotional challenges, like divorce, retirement, disappointing children. If you're hearing voices, or if you walk into my office and announce that you've decided to kill yourself, as someone did not long ago, I know exactly what to do: escort you to a psychiatrist.... This winter, I'll see more patients with seasonal-affective disorder than the flu, and the tissues in my exam room will dry tears more often than they muffle sneezes. The problem is, I lack the time or training to diagnose and manage many psychiatric disorders. And some that I'm probably not all that great at doing so. Still, over a third of all mental-health care in the U.S. is now provided by primary-care doctors, nurse practitioners, pediatricians, and family practitioners." Dr. Koven speaks about this article, and about her work as a writer, doctor, and writer/doctor more generally, on today's program.