Newsletter

Trust and Verification2025-12-01

Who to trust and what to do for healthcare is a problem, for patients and families. In particular in psychiatry, the convergence of lack of objectivity, poor outcomes, and a re-evaluation of what has been done over the last three decades has created a crisis of confidence.

All three issues have to be addressed in order to restore trust and clarity for patients and families.

Objective testing is available. From the newer blood biomarker RNA tests that help with assessment and matching to treatments, to older DNA tests that help with deciding which doses of medications to use, to classic metabolic panels that look at physiological abnormalities that can affect brain functioning (diabetes markers, thyroid and sex hormones, B and D3 vitamins, magnesium, omega-3/omega-6 index). The purveyors of such tests should be judged based on their published science, accreditation, and track record. Large laboratory companies such as Quest and Labcorp can serve as portals for mass adoption by partnering with the specific specialized labs that offer these tests, and putting them on their menu. Self-pay with HAS dollars may be the route patients and families have to take for now, but in the years ahead smart payers (insurance companies, governments) will start covering them as the data on their impact on reducing healthcare costs and improving outcomes accumulates and gets published.

The issue of outcomes requires a cultural change. Every practitioner, every clinical system, every hospital, should be required to post aggregate outcomes on their website, for people to judge. Those that do not, should be avoided by patients and families. Three metrics are important: progressive decrease of healthcare utilization per patients (within-patient decrease in frequency of visits and days of hospitalization over time), improved functional outcomes for patients as measured by online surveys of success in daily life functioning, and increased patient well-being/satisfaction, trackable through an app.

The re-evaluation of what has been the norm in psychiatry in the last three decades or more can lead to positive changes rather than recriminations. For diagnostic classification, making them more dimensional, data driven, and personalized will be a big step forward and is achievable over the next few years with a fresh look at existing and accumulating data. For medication prescribing, one size does not fit all, treatments have to become much more personalized, minimalistic, and curative in intent. Clinicians should be paid for making and keeping people healthy, not make their income from recurring visits of patients deemed chronically ill.

With precise, personalized, and preventive psychiatry, all the above can be set in motion now, not in some utopian future.