Modern Times and Quality of Care

To the Editor: The March 2005 issue of Psychiatric Services featured many articles focusing on quality of care, especially care provided in outpatient settings. However, the articles did not address the issue of "time slots" for patients seen by psychiatrists in these settings.

Psychiatric illnesses, like any other medical disorders, used to be reviewed in three different stages—all starting with the letter R: remission (a symptom-free state); recovery (an illness-free state); and rehabilitation (a state free of sociofamilial, educational, and vocational problems). In recent years, we have not been giving much consideration to rehabilitation, although recovery is now receiving some attention.

Nowadays, psychiatrists are expected to see one patient every 15 minutes, which permits time only for a review of symptom remission—an assembly-line approach reminiscent of Chaplin's Modern Times. How can we be sure that high-quality care is delivered under these circumstances?'

Dr. Ulus is affiliated with the behavioral health outpatient clinic at St. Vincent Hospital in Erie, Pennsylvania.