If the AMA really did have the best interests of physicians in mind and wanted to do something good for patients and physicians, they’d forget about their lousy advertising campaigns and commission a whole line of books just like the newest literary work from the folks over at the Shrink Rap blog, Dinah, ClinkShrink and Roy.  Every specialty could use one.  More on that in a bit.

For those of you who may not follow their blog regularly or may not have noticed it in the “Clinical Care” section of Healthcare Roundup, Shrink-Rap-the-blog is hosted by three enterprising psychiatrists from Maryland, whose real names are Drs. Dinah Miller, Annette Hanson and Steven Daviss.  The members of this trio happen to practice in very different clinical environments: Dinah is a general adult outpatient psychiatrist, Annette works in prison as a forensic psychiatrist, and Steve works in a general hospital setting.  Together with their guest bloggers they regularly produce an entertaining blog (and separate My Three Shrinks podcast) “by psychiatrists for psychiatrists”.

In Shrink-Rap-the-book, they’ve taken on an entirely different task – that of explaining the basic art, science and economics of psychiatry to those of us who aren’t psychiatrists.  Why?  Who knows?  Maybe it’s a piece of self-prescribed psychotherapy.  But the result is superb on many levels.

Shrink Rap the book tries to several things simultaneously.  As a guide for patients and their families it takes the reader through a number of prototypical (but imaginary) cases in which patients have common mental illnesses.  These include depression, bipolar disease, anxiety disorders, addictions, schizophrenia, antisocial personality disorder and others.  The authors use these cases as an opportunity to teach patients and families about the process of psychiatric evaluation and diagnosis, as well as specific therapies such as medications, psychotherapy and electroconvulsive therapy (ECT).  The result is a surprisingly readable lesson on what to expect from the psychiatric process.

But rather than just stopping there, the trio also does something that is a great service to all clinicians: they also write about the economic, administrative, legal and political environment under which physicians and patients must operate when dealing with these conditions.  The addition of this information is a great gift because frankly it’s impossible for anyone to truly understand what’s happening (and why), without it.  Doctors and patients can’t necessarily do things just because they make sense medically and/or socially; there are many other factors at work.  It’s absolutely critical to the future of medicine that patients and their families understand this.

For clinicians, medical students, residents and those simply interested in this field of medicine, the book offers another perspective entirely.  Each of the authors provides a description of what clinical practice is like in his or her respective environment: outpatient clinical practice, hospital-based psychiatry or corrections.  This brought back memories of my own days as a fourth year medical student rotating between the clinic, the hospital (including the locked wards in the public hospital in St. Louis), and the emergency room.  It would have been great to have been better prepared for the experience with a book of this kind.

Finally, there is Shrink Rap, the book, as a piece of literature.  There’s good news on this front as well.  All three authors are fine writers and succeed in keeping the story flowing.  In fact, based on what it appears the authors were trying to achieve, it’s hard to come up with a single useful criticism.

Getting back to the point I made earlier in this review, there is no question in my mind that Shrink Rap represents the type of communication and education that the medical community needs to be doing in order to redefine the profession in the minds of patients, families and the general public.  Physicians have allowed others to define them, especially their motives and the extent of their power, for far too long.  Under this scenario, doctors are selfish luddites; deliberately holding the healthcare system hostage with their resistance to “progress” in the form of electronic medical records, their reluctance to willingly participate in counterproductive insurance plans such as Medicare and Medicaid, and use of expensive medications rather than spending time with patients. The reality is, of course, quite different. Clinicians live in a world forced on them by the government and insurers.  It’s a world that often makes it impossible to provide good, economical care.  As a result politicians and other special economic interests have a great deal to gain by portraying clinicians as greedy, omnipotent villains.  It makes it easier to shift the blame for rising costs, poorer service and piles of paperwork from the administrators onto the folks in the trenches.  Removing clinicians from the moral high ground is a crucial step in the process.

Books like Shrink Rap present a problem for politicians and bureaucrats in that they present the promise and limitations of modern American medicine to the public in a direct, honest and understandable way.  The only thing worse for the folks behind schemes like the mandatory deployment of complex, expensive electronic records and largely useless “quality” programs would be to see dozens of similar books hit the shelves and television airways – each focusing on a different medical specialty.  The public should have a general understanding of important illnesses as well as the relative roles of patients, clinicians, and the economic, medical and political environments in treating them.  It would make the discussion of healthcare reform a great deal more meaningful.  This edition of Shrink Rap is an excellent beginning.

The bottom line: if you or anyone you know has any interest in the world of psychiatry, do them a favor and have them “Shrink Rapped”.  It’s a very worthwhile read.