A tweet-eager MD postured the controversial argument below that “treatment-resistant mental illness” be replaced with “in need of referral to another clinician”.

I advocate being weary of Dr. Palmer’s sentiment, specifically referrals to another clinician as any final “conclusion”. While second opinions and peer reviews are always useful, “kicking the patient can” too leisurely can backfire.

In my experience, referral mechanisms can be used to evade accountability while also removing the original clinician from treatment conclusion. Like punting the ball to the other team then leaving the game and never practicing.

Was clinician wrong? Did clinician make a mistake or oversight? Clinician would never know.

So “treatment failure” then becomes this ethereal unattainable line in the sand never drawn, used as a tool for low quality clinicians to evade failures: patient’s and their own.

I’ve seen some clinicians get personally offended at even considering treatment failure.

Giving an out via referral benefits only provider at the sole risk of patient alone.

Clinician staying included post-referral for long term patient conclusions is ideal (peer review vs new provider referral). Maintains clinician integrity while offering constructive growth.

The subjective nature means treatment failure needs tested to ensure client isn’t failing patient. Including original clinician in testing is key. Else you perpetuate inside a professional vacuum.

It also insinuates problematic subjectivity in treatment. Implying that social dynamics are the cause of failure, not treatment protocol or hard data.

I think this risks watering down the conclusion that is “treatment-resistant mental illness”, or shifting the definition entirely. All at patient risk alone (no risk to clinician at all).

Respectfully my opinions alone (20 years client/patient experience)

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