Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Sunday, January 11, 2015


I got one of those conference brochures today, "Comprehensive Training Course in Acupuncture for Physicians", which is really a multi-phase course, with phases 1 and 3 online, and phase 2 for 10 days, on site, at UC Irvine.

I'm not attempting to write about acupuncture. I'm not even qualified to begin thinking about acupuncture. I didn't even spell it right, initially. I'm simply going to quote from the "Statement of Need".

"Acupuncture treatment is extensively sought by a vast segment of the patient population. A significant and growing body of evidence also indicates the efficacy of such complementary treatments for a wide variety of clinical indications. Acupuncture is now, in many cases, a physician reimbursable procedure with third-party payers, thus reflecting its acceptance as good medical practice..."


I'm finding it difficult to form my thoughts about this into sentences. Granted, it's not claiming that the fact that a procedure, in this case acupuncture, is reimbursable implies or proves that said procedure is good medical practice. Nor is it claiming that insurance companies get to decide what is and isn't good medical practice (not officially, anyway). It's simply claiming that acupuncture is widely accepted as good medical practice, and this is reflected in the fact that insurance companies are willing to reimburse for it.

The statement DOES imply that if you, as a physician, want to make money, one way to do this is to do procedures, such as acupuncture, that insurance companies classify as good medical practice and are therefore willing to reimburse. But that's not what bothers me. I have, on several occasions, expressed the opinion that it isn't evil for doctors to want to make a good living. It's simple supply and demand with a third-party twist: people want acupuncture, someone else will pay for it, so give them acupuncture.

What bothers me is the casual lumping together of "good medical practice" and "reimbursable". I keep wondering when the lightbulb will go on, and people will realize that, like casinos, insurance companies are not in business to lose money. They care about "good medical practice" only insofar as that practice costs them less or makes them more money than another practice. They are not kind friends happy to help in your hour of need.

And boy do they love a quick fix. 15 minute med checks? Yes, please! Integrated care, with no psychiatrist in sight? I'll take some o' that! Years of painful, soul-searching struggle to unlearn a lifetime of pathologic interactions with the world, and no PHQ-9? Bad practice!

1 comment:

  1. You are correct.

    There are an endless stream of things that are considered "good medical practice" these days. They are both reimbursable and not reimbursable depending on which business player is involved. In my early days of practice I was fascinated by quantitative EEG. I was lucky enough to work with a board certified electrophysiologist and his team of outstanding EEG techs. Despite a publication in the journal Science outlining all of the theory, mathematics, and experimental studies on the device and its algorithms we determined that it was not a worthwhile or accurate test. During the entire time, we considered the commercially marketed equipment to be experimental and did not charge for the procedure. We were provided with a sheet of billing codes that could be used for billing purposes.

    I have even less faith in acupuncture, although I am sure that it is in high demand.

    I am always amazed that physicians feel a need to go outside of their specialty. There is enough to learn within that boundary.