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Tijdschrift voor Psychiatrie 58 (2016) 7, 520 - 528

Essay

Red tape in psychiatry: on bureaucracy, bureaucratism, and our secret fondness for procedures

J.D. Blom, F.R.E. Smink, E.V. Kwidama, V.M. Vladár Rivero

background A frequent complaint in psychiatry is that the psychiatrist-patient relationship and the quality of care are hampered by bureaucratic processes.
aim To provide an analysis of various types of bureaucracy in psychiatry that can serve as a starting-point for the improvement of care and the performance of qualitative studies.
method We conducted an exploratory study using PubMed, Google, and various Dutch medical journals.
results Contemporary psychiatry is characterised by a bureaucratic organization structure. Mental, somatic, and social problems are translated in a standardised manner into medical jargon which gives rise to a dsm diagnosis, a cost-price, and outcome measures. This medical-bureaucratic system has important virtues, provided it is applied efficiently and the patient-psychiatrist relationship remains intact. In the Netherlands, however, this balance has been disturbed. Future research can be facilitated if distinctions are made between various types of bureaucracy (referred to here as Hippocratic, Weberian, and Kafkaesque bureaucracy). In addition, we discuss various national initiatives which aim to counter bureaucracy, including initiatives of the Dutch government.
conclusion If the patient-psychiatrist relationship is to regain its central role, bureaucracy needs to be countered constantly. The government can facilitate this process, but healthcare providers can also play a key role and meanwhile help to bring about a substantial reduction in the costs of care.

keywords bureaucracy reduction, healthcare system, overhead, professional autonomy, regulatory burden