A Clinician and a Poet: Reimagining the 15-Minute Med Check.

Citation metadata

Author: Ronald W. Pies
Date: Aug. 2021
From: Psychiatric Times(Vol. 38, Issue 8)
Publisher: Intellisphere, LLC
Document Type: Article
Length: 1,965 words
Lexile Measure: 1510L

Document controls

Main content

Article Preview :

Seventeen years ago, I published a piece in Psychiatric Times[TM] titled "The Poet and the Psychiatrist." In the article, I alluded to "an unusual therapy group" I co-led as a resident nearly 40 years ago, in which psychiatric inpatients "... were encouraged to bring in poetry--whether their own or that of others--and read it to the group. A psychiatric nurse and I encouraged discussion of the feelings, images, and memories the poems would almost invariably evoke." (1)

Poetry readings were often a space where patients who rarely expressed their feelings in the course of a formal therapy session felt they could speak freely. Sadly, the very idea of conducting such a group in today's climate of truncated psychiatric care can seem quaint or naive, at best. This point was brought home to me while reading February's "Letter From the Editor," in which Psychiatric Times' Editor-in-Chief, John J. Miller, MD, detailed the economic pressures on psychiatrists over the past 30 years that have led to the now-infamous "15-minute medication check." (2)

Miller pushed back on this procrustean limit by suggesting--or, at least, imagining--that psychiatrists extend the session to 16 minutes. The extra minute, he suggested, could be used to gain some important personal information about the patient. Questions might include, for example, "Who do you feel had the greatest influence on you growing up?" or "When do you feel most at peace with yourself?" or "What do you do for relaxation?" (2)

Riffing off his suggestion, I would like to propose another question we might put to certain suitable patients--a question I raise as both a clinician and a poet. (3) But first, I would like to examine the whole notion of the medication check, with the aim of reimagining it as something more than a superficial exercise in refilling a script.

More Than 15 Minutes

For starters, I urge psychiatrists to resist the 15-minute med check model, wherever and whenever possible. I realize that will not be greeted with enthusiasm in most managed care settings, but I think there are good reasons--and compelling ethical imperatives--why we should push back hard. As child psychiatrist David Rettew, MD, succinctly put it (4):

In 15 minutes ... there is barely enough time to go over side effects, dose and medication changes, and informed consent, let alone engage in discussions about what may really be going on in a patient's life and how a multitude of other possible interventions (improving sleep, exercise, nutrition, relationships) might be useful.

There is good reason to believe that resistance is not always futile. For example, Lorraine Roth, MD, commented in 20115:

I retired from the VA last year and have worked a number of Locum Tenens positions since then. One was at a mental health clinic that needed a psychiatrist to cover for a few months. They stated that evaluations were 1 hour, med checks 15 minutes. I said I need 30 minutes. I explained that 15-minute checks are...

Source Citation

Source Citation   

Gale Document Number: GALE|A676443364