Psychiatrist acknowledges that medicine plays no part in psychiatric diagnosis

From Psychiatry Today Daniel Carlat has an article on how one need not be a psychiatrist, nor a medical doctor to diagnose because psychiatric diagnosis is not medicine. Nice to have a reputable psychiatrist spell it out so nicely. This is an excerpt from the article:

Each DSM diagnosis is primarily a list of behaviors and psychological symptoms, none of which require medical training to recognize. In fact, with a few exceptions, such as alcohol withdrawal, there are no DSM disorders listing either lab tests or physical exam findings as criteria for the diagnosis. Therefore, for the vast majority of the 300-plus diagnoses included in DSM, medical school training is not needed.

One might argue, however, that users of DSM require medical training in order to rule out a medical condition that may be secretly mimicking an apparent psychiatric disorder. But when psychologists and social workers make a psychiatric diagnosis, they generally ask patients if they have seen their primary care doctor to rule out an organic cause. I do not believe that medical school is required to train therapists to ask this question, nor to ask about certain common symptoms that are red flags for medical illness.

Furthermore, we psychiatrists are hardly immune from missing occult medical issues. Our practices tend to be much busier than those of therapists, and many psychiatrists do brief 30- to 45-minute evaluations and spend 15 to 20 minutes with patients for psychopharm follow-up visits. In such settings, it is likely that medical issues (not to mention psychosocial issues) are missed regularly. Whether we, in fact, do a better job of “catching” hidden medical problems than our therapist colleagues is an empirical question, and I am not aware of any research that has attempted to answer this question.

At any rate, it is indisputable that the core diagnostic work in psychiatry is psychological, and is not medical. During a DSM diagnostic interview, I might spend 5% of my time—if that—calling upon my medical school knowledge to rule out a medical problem. The other 95% of my time is spent obtaining a social and psychiatric history, and doing a detailed mental status exam. This work does not require stethoscopes, blood tests, or PET scans. It requires mind-to-mind contact with my patient—again, something that psychologists and social workers are quite skilled at. read the rest

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