Psychiatrist, Advocate for Patient Care

Chapter 2: Canary in the Coal Mine


In the practice of psychiatry, outside influences that emphasize time, resource limitations, and pre-defined outcome measurements directly affect delivering care to individuals like Joyce. Moreover, the arbitrary imposition of care restrictions for any patient can negatively affect best outcomes. This is true across most medical specialties.


When asked about their least satisfying experiences in medical practice by the Physicians Foundation in its latest survey, physicians emphasized, “regulatory/paperwork burdens” and the “erosion of clinical autonomy.” Clinical autonomy is the knowledge that the physician has the final say when dealing with a patient and is free to make his or her best recommendation to meet an individual’s medical or mental health need.


Physicians spend four years in college, four years in medical 

school, and three to seven years or more in residency or fellowship

training in order to practice in their chosen specialty.

They then often find that their ability to make what they believe

are the best decisions for their patients is obstructed or

undercut by bureaucratic requirements or third parties who are non-physicians.


More than 72 percent of physicians surveyed indicated that external factors adversely affected patient care. Clearly, most physicians share a frustration with outside interference. I believe, however, that the influences affecting psychiatry, often unseen, indicate that something more serious is unfolding in the practice of medicine systemwide.


Think of the psychiatrist as a canary in a coal mine. Coal miners carried caged canaries deep into mine shafts to warn them of deadly carbon monoxide poison. The miners knew of the threat but could not see or smell carbon monoxide. Instead, they saw carbon monoxide’s deadly results as it slowly robbed the air of oxygen and began to dull their senses. Soon, the miners would fall asleep and eventually die.


Canaries, however, are hypersensitive to the oxygen supply and would quickly die if carbon monoxide penetrated a mine shaft. The canary’s quick death signaled to the miners that they needed to hurry to get out into fresh air.


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