The “Med Check”

A major myth in contemporary psychiatry, repeated by psychiatry residency directors and their residents, is the cliché “ ‘Psychopharm’ is easy; psychotherapy is hard.” The truth is that learning psychopharmacology is as hard as learning psychotherapy—perhaps harder, because it entails not only knowledge about medications, but knowledge and skill about diagnosis, about interviewing, and about relating to the patient. The follow-up psychopharmacology visits occur after the initial diagnostic interview. Often pejoratively called “med checks,” such visits tend to consist of brief symptom assessments, followed by pill adjustments for symptoms. Pill-for-symptom treatment is poor psychopharmacology, and therefore an inappropriate focus. Instead, follow-up visits need to be long enough to allow for attention to the interpersonal relationship, such as transference. Again, the use of psychotherapeutic methods is helpful. Such an approach will enhance adherence, the lack of which is a major aspect of treatment failure.