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Important point.

ANything related to the establishment and maintenance of a therapeutic relationship between provider and patient is for the most part, not reimbursed. This includes counseling, coaching, teaching and discussion time - across all clinical settings and specialties and not just mental health.

It's one of the disturbing factors that, in my view, has moved the nature of the patient focus to procedural intervention and medication and away from caring, coaching, teaching and partnership with patients.

I see it in the corporate, assembly line widget approach to patient treatment and the minimal or absent longstanding and personal patient/nurse/physician relationship.

But it leads to higher rates of patient noncompliance, to admission recidivism, to higher costs overall, and to preventable morbidity and mortality, all in the name of efficiency.

The pendulum will have to swing in the other direction at some point, but the generation of professionals who are expert in using therapeutic tools will be close to retiring, so time is of the essence.

Thanks Annie, and I hate to sound like a pessimist, but if time is of the essence do you think things will really change in time? I have a sinking feeling that answer is "no way."

Well.... If I could prognosticate, I'd say that the multifactored crisis of lack of affordability and access, the increasing critical physician and nurse shortages, and the public dissatisfaction with healthcare may drive the bus over a critical tipping point and rapid change. I just hope it leads to change toward preventive care, stabilized relationships with primary care providers (advanced practice nurses and primary care and family physicians) and away from a competitive, free-market, corporatist procedure and profit-oriented service mentality.

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