Placing High Demands on Primary Care

Letters to the Editor Patients With Personality Disorders in Everyday Clinical Practice—Implications of the ICD-11 by Prof. Dr. med. Sabine C. Herpertz, Dr. med. Isabella Schneider, Prof. Dr. Babette Renneberg, and Prof. Dr. med. Antonius Schneider in issue 1–2/2022

The article (1) is making substantial demands from readers, and in the ideal case also from primary care providers looking after such patients. By this we mean primary care providers such as doctors working in the specialties general practice, internal medicine, gynecology, orthopedics, etc, and—only if those specialists do not succeed in stabilizing such patients—from specialists in psychiatry and psychotherapy.

On applying the statistical data in the article (1) to routine clinical practice, one might conclude that daily treatments of such patients are the norm as the population/cohort is huge. Compared with routine clinical practice in primary care, the diagnostic demands shown in Table 1 and the checking of the criteria in Figure 1 over a time period of two years is very high. Who can afford that in terms of subject matter and time according to the ICD-11? To whom is the article really directed? It seems, rather, for psychiatrists and psychotherapists—but are their numbers sufficiently high? Current waiting times of 6–12 months show that the Associations of Statutory Health Insurance Physicians provide completely insufficient planning data and distributions of practice seats. The scientifically highly valuable article (1) therefore passes reality by—or is it meant to be an incentive to allow primary care providers more time to meet the listed challenges, or even a plea for larger numbers of psychotherapists and psychiatrists in the Associations of Statutory Health Insurance Physicians planning?

A practically important tip should be added to the checklist of how to deal with such patients: Balint groups train participants precisely for how to deal with problematic patients. But too few doctors participate in continuous Balint groups.

DOI: 10.3238/arztebl.m2022.0189

Dr. med. Wolfgang Baur

Facharzt für Allgemeinmedizin

Facharzt für psychosomatische Medizin und Psychotherapie

Lehrbeauftragter Uni Göttingen a. D.

Goslar Immenrode

Conflict of interest statement

The author declares that no conflict of interest exists.

References

1. Herpertz SC, Schneider I, Renneberg B, Schneider A: Patients with personality disorders in everyday clinical practice—implications of the ICD-11. Dtsch Arztebl Int 2022; 119: 1–7