LETTERS
methods cific
can
then
treatment
be developed, of this
to cope group.
problems
with
some
of the
spe-
The premise that homogeneous outcome is the test of diagnostic validity is debatable. Shared etiobogical factors may be an equal measure of diagnostic validity and can also lead to more effective and specific treatment. Unfortunately, establishing unequivocally that any psychiatric diagnostic group has either a homogeneous etiology or a homogeneous course of illness
is not
dent
demands
on
other
psychiatric
many
currently
possible. the
It seems
borderline
unfair
to place
classification
than
more for
the
in DSM-I1.
syndromes
THE
EDITOR
Many of us who have worked in chronic psychiatric hospitals would be reluctant to use the barge numbers of people housed there as evidence of more or better psychiatry being practiced in such places. I see the task force report as the first ganization to show interest in the private in this
country.
manent could private
I would
committee
if people
stri-
exist
TO
hope
that
on private
in the
public
use their practice,
APA
would
practice.
sector,
time and which
feeble effort by any orpractice of psychiatry
like
establish
It would
Dr.
a per-
be very
Sharfstein
and
influence to increase our is of pressing importance
helpful
associates,
knowledge on and sorely
lacking.
G. GUNDERSON, Belmont,
JOHN
M.D.
Mass.
REFERENCES
I. Task
Force
terns
Private
Practice:
SIR:
I would
More
Data
are
of
Health
Needed
tion,
by
Steven
tice
S.
and
to take
Sharfstein,
M.D.,
Accountability:
Report
on Private
I was
of
Practice” to read
the
with and
some
current
opinions
associates
A Response
encouraged
sessment
issue
in “Private
to the
APA
(January
1975
issue).
that
goal
was
their
contribution
of
expressed Prac-
Task
3.
Force
private
balanced
as-
practitioners,”
apparently in relation to accountability, quality assessment, and economic factors. I was disappointed to discover that the article did not present new information about private practice and limited itself to questioning the credibility of the task force re-
port
Services.
past
authors have
the
noted
centered
sector.”
Future in
The
authors
that
far
“in
more
same
may
are
affiliated,
general,
in the
be true
for
the
APA’s
public
concerns
sector
than
National
iW:
Community
Dr. Sharfstein
private
with
Institute
DC, American
of Mental
The
SIR:
understands
and of
California)
patients,
dividuals
a year
my
practice,
own
found
definitely
that
Dr.
the
matter
saw the
and
has
been
the average
of Dr. Sharfstein on this
of
average
and this is less than
light
they
Sharfstein
in the area. The second issue I want lapping and resultant inability private and public practice.
speculations
that
in excess
equably figure
large
of
268
num-
1 12 new
associates
in-
suggest.
for
the
for the senior
Psychiatric
last
In four
record
service
by eclectic
private
article.
Jolliff My
own
psychiatry.
Am i
patients. emergency 1970
Dis
Nerv
room
serv-
study: health care delivery and private mental hospitals.
and Associates aim
(2) shed experi-
stand
in New J Leg
A. MUNOZ, Sheboygan,
M.D. Wis.
Reply
article Our
by the data the
was
to place
paper
should
the not
task be
force
report
construed,
as
it
fact
presented
in our
the number
that
paper.
Dr.
of new
Munoz
patients
mis-
seen
by
private practitioners varies depending on the location and type of psychiatric practice. There is probably wide variation in the number of patients seen by private practitioners, and the figures quoted in our paper reflected an average based on the limited data that were available. In rereading JoIliff’s article, we see that it does not contradict our findings as Dr. Munoz indicated. In fact, it supports our assertion on the overlapping of public and private care.
ship
is mistaken between
establish the health needs.
The further
studying
private
sector
would
welcome
It seems to me misleading to compare the volume of work at a public facility with that of a private practice. It is quite clear
task. atric
that public facilities in large cities are the emergency rooms of the poor. My experience in a psychiatric emergency room (4) attests to the large volume of patients seen in the public facility,
cussions
quantity that
with quality
we seem
volume
and
extent
to
National
ence (3) would tend to confirm Jolliff’s conclusions, which are not fully in accord with those of Dr. Sharfstein and associates.
but the volume itself may not add to the quality of service. comparative study that would suggest a negative relation tween volume and quality has been presented by Memmola
of our
perspective.
We do not equate
mention is the supposed overto distinguish accurately between Again, this is based mostly on the recent
Associa-
straight.
We
psychiatrist
to
and his coauthors.
Mental
apparently was by Dr. Munoz, as an attack on private psychiatry. However, since the task force report contained errors and misinterpretations of data, we felt it was important to set the
Munoz
in his
of
which
may see far less than 259 different new patients a year. Their paper claims that this figure, given for California, is “particularly atypical of the nation as a whole.” When I led a panel discussion on private practice at APA’s annual meeting in Detroit, the panel members (from New York, New Jersey, Illinois, Wisconsin,
of Pat-
Delivery
in the
the
the organization
Importance
the
RODRIG0
in a total
much
Washington,
5. Memmola LK: A comparative Jersey county, state, federal. Med 2(6):3I -40, 1974
Health of the Alcohol, Drug Abuse, and Mental Health Administration. I want to comment on two issues. First, we do not have national figures on the number of new patients seen by private practitioners. I think it dangerous for Dr. Sharfstein and associates to arbitrarily decide that physicians in private practice
years,
and
Practice
( 1).
The
bers
Present
Psychiatry 131:976-980, 1974 Munoz RA: One hundred private psychiatric Syst 35:358-361, 1974 Munoz RA, Tuason VB, Dick E: Psychiatric ice patterns. Compr Psychiatry 1 1: 185- 189,
4.
“a
6: The Psychiatric
1973
2. iolliff like
Report
Private
Institute
quality.
which
It
of Mental
cooperation
on
Health
national
health
better private.
relationhowever,
practice
fulfills
is very interested
in
private
sector
understanding would aid
in this
of psychipresent dis-
insurance.
STEVEN
A be(5).
S.
SHARFSTEIN,
M.D., CARL
IRVING
D. GOLDBERG,
M.P.A. TAUBE
M.P.H.
Rockville,
AmJ
to
public
of the contribution of the needs of the nation and
of the
As we stated in our article, practice, both public and
and Dr.
a positive
is important,
private
the extent and nature to the mental health
the
in our article
to suggest
Psychiatry
/32:8,
August
/975
Md.
877
methods cific
can
then
treatment
be developed, of this
to cope group.
problems
with
some
of the
spe-
The premise that homogeneous outcome is the test of diagnostic validity is debatable. Shared etiobogical factors may be an equal measure of diagnostic validity and can also lead to more effective and specific treatment. Unfortunately, establishing unequivocally that any psychiatric diagnostic group has either a homogeneous etiology or a homogeneous course of illness
is not
dent
demands
on
other
psychiatric
many
currently
possible. the
It seems
borderline
unfair
to place
classification
than
more for
the
in DSM-I1.
syndromes
THE
EDITOR
Many of us who have worked in chronic psychiatric hospitals would be reluctant to use the barge numbers of people housed there as evidence of more or better psychiatry being practiced in such places. I see the task force report as the first ganization to show interest in the private in this
country.
manent could private
I would
committee
if people
stri-
exist
TO
hope
that
on private
in the
public
use their practice,
APA
would
practice.
sector,
time and which
feeble effort by any orpractice of psychiatry
like
establish
It would
Dr.
a per-
be very
Sharfstein
and
influence to increase our is of pressing importance
helpful
associates,
knowledge on and sorely
lacking.
G. GUNDERSON, Belmont,
JOHN
M.D.
Mass.
REFERENCES
I. Task
Force
terns
Private
Practice:
SIR:
I would
More
Data
are
of
Health
Needed
tion,
by
Steven
tice
S.
and
to take
Sharfstein,
M.D.,
Accountability:
Report
on Private
I was
of
Practice” to read
the
with and
some
current
opinions
associates
A Response
encouraged
sessment
issue
in “Private
to the
APA
(January
1975
issue).
that
goal
was
their
contribution
of
expressed Prac-
Task
3.
Force
private
balanced
as-
practitioners,”
apparently in relation to accountability, quality assessment, and economic factors. I was disappointed to discover that the article did not present new information about private practice and limited itself to questioning the credibility of the task force re-
port
Services.
past
authors have
the
noted
centered
sector.”
Future in
The
authors
that
far
“in
more
same
may
are
affiliated,
general,
in the
be true
for
the
APA’s
public
concerns
sector
than
National
iW:
Community
Dr. Sharfstein
private
with
Institute
DC, American
of Mental
The
SIR:
understands
and of
California)
patients,
dividuals
a year
my
practice,
own
found
definitely
that
Dr.
the
matter
saw the
and
has
been
the average
of Dr. Sharfstein on this
of
average
and this is less than
light
they
Sharfstein
in the area. The second issue I want lapping and resultant inability private and public practice.
speculations
that
in excess
equably figure
large
of
268
num-
1 12 new
associates
in-
suggest.
for
the
for the senior
Psychiatric
last
In four
record
service
by eclectic
private
article.
Jolliff My
own
psychiatry.
Am i
patients. emergency 1970
Dis
Nerv
room
serv-
study: health care delivery and private mental hospitals.
and Associates aim
(2) shed experi-
stand
in New J Leg
A. MUNOZ, Sheboygan,
M.D. Wis.
Reply
article Our
by the data the
was
to place
paper
should
the not
task be
force
report
construed,
as
it
fact
presented
in our
the number
that
paper.
Dr.
of new
Munoz
patients
mis-
seen
by
private practitioners varies depending on the location and type of psychiatric practice. There is probably wide variation in the number of patients seen by private practitioners, and the figures quoted in our paper reflected an average based on the limited data that were available. In rereading JoIliff’s article, we see that it does not contradict our findings as Dr. Munoz indicated. In fact, it supports our assertion on the overlapping of public and private care.
ship
is mistaken between
establish the health needs.
The further
studying
private
sector
would
welcome
It seems to me misleading to compare the volume of work at a public facility with that of a private practice. It is quite clear
task. atric
that public facilities in large cities are the emergency rooms of the poor. My experience in a psychiatric emergency room (4) attests to the large volume of patients seen in the public facility,
cussions
quantity that
with quality
we seem
volume
and
extent
to
National
ence (3) would tend to confirm Jolliff’s conclusions, which are not fully in accord with those of Dr. Sharfstein and associates.
but the volume itself may not add to the quality of service. comparative study that would suggest a negative relation tween volume and quality has been presented by Memmola
of our
perspective.
We do not equate
mention is the supposed overto distinguish accurately between Again, this is based mostly on the recent
Associa-
straight.
We
psychiatrist
to
and his coauthors.
Mental
apparently was by Dr. Munoz, as an attack on private psychiatry. However, since the task force report contained errors and misinterpretations of data, we felt it was important to set the
Munoz
in his
of
which
may see far less than 259 different new patients a year. Their paper claims that this figure, given for California, is “particularly atypical of the nation as a whole.” When I led a panel discussion on private practice at APA’s annual meeting in Detroit, the panel members (from New York, New Jersey, Illinois, Wisconsin,
of Pat-
Delivery
in the
the
the organization
Importance
the
RODRIG0
in a total
much
Washington,
5. Memmola LK: A comparative Jersey county, state, federal. Med 2(6):3I -40, 1974
Health of the Alcohol, Drug Abuse, and Mental Health Administration. I want to comment on two issues. First, we do not have national figures on the number of new patients seen by private practitioners. I think it dangerous for Dr. Sharfstein and associates to arbitrarily decide that physicians in private practice
years,
and
Practice
( 1).
The
bers
Present
Psychiatry 131:976-980, 1974 Munoz RA: One hundred private psychiatric Syst 35:358-361, 1974 Munoz RA, Tuason VB, Dick E: Psychiatric ice patterns. Compr Psychiatry 1 1: 185- 189,
4.
“a
6: The Psychiatric
1973
2. iolliff like
Report
Private
Institute
quality.
which
It
of Mental
cooperation
on
Health
national
health
better private.
relationhowever,
practice
fulfills
is very interested
in
private
sector
understanding would aid
in this
of psychipresent dis-
insurance.
STEVEN
A be(5).
S.
SHARFSTEIN,
M.D., CARL
IRVING
D. GOLDBERG,
M.P.A. TAUBE
M.P.H.
Rockville,
AmJ
to
public
of the contribution of the needs of the nation and
of the
As we stated in our article, practice, both public and
and Dr.
a positive
is important,
private
the extent and nature to the mental health
the
in our article
to suggest
Psychiatry
/32:8,
August
/975
Md.
877
