The Clinician's Guide to Managed Mental Health Care.

When I was in medical school and then in residency, I learned a lot of things. In many areas, I was brimming with theories, facts, and technical skills. But one thing I never learned was how to do the practical things a doctor must do in order to survive - run an office or find a job, schedule patient appointments, even make patients pleased with the service I provided to them. At the time, it was clear to me that my teachers did not know much about these things either - maybe that's why they never taught them. I still remember vividly how, in the outpatient clinics, all patients were given appointments for one of the two available times each day - 8 a.m. or 1 p.m. The result was that hundreds of patients would arrive at more or less the same time and then wait uncomfortably for hours to be seen. No one ever seemed to be concerned to find a better way to do this. Indeed, the overconscientious (by the standards of that time) physician who looked for some published discussion on organizing medical services better would be hard put to find any.

Fortunately, things are somewhat better these days. Although formal training programs still seem to neglect many of the basics of performing the physician's role, you now can find many articles and books on how to run your office, get your bills paid, or safely sign a contract with an organization that will send you patients.

The Clinician's Guide to Managed Mental Health Care is an example of this literature. Managed care - the wave of the future, according to many experts - is something every physician needs to understand. Yet the confusing collection of acronyms and initialisms, legal cases, terminology, and new legal risks makes the area a potential minefield. Managed care in mental health is perhaps a little bit more advanced than in the other areas of medicine because cost controls have been a major issue longer there.

The Clinician's Guide is an excellent introduction written by someone who is obviously familiar with the field from practical experience. Its purpose is to provide the naive clinician with the background necessary to evaluate an HMO affiliation or respond to a denial by a utilization management company The 10 chapters go step by step through the major areas of the field, and the six extensive appendices provide detailed information and sample documents There is also a small glossary and an address list of major organizations. I highly recommend the book for use by mental health clinicians (many of whom are not physicians) who need an introduction to managed care. It is clearly and simply written and attractively printed.

The usefulness of The Clinician's Guide for physician executives is another matter, however. Most physician executives' concerns with managed care go beyond mental health. Although many of the principles and facts discussed in the book are applicable to other medical specialties or to general managed care, few who are interested in the other areas will want to go through the mental health material to get at what they want. Even physician executives concerned with mental health services are likely to find this book too elementary and too concentrated on the individual clinician's perspective to be of use. Thus, I cannot recommend the book for physician executives except to use as a gift for mental health clinician colleagues. It would also be a good addition to the library of a hospital with a mental health service.