I do primary care in a public mental health clinic. Your article completely resonates with me. It’s frustrating because so often I feel like I’m working at cross-purposes not in tandem with the 10 or so psychiatric prescribers (MDs, NPs, pharmacists) at my site. Many of them are nice and well-meaning but caught up in the way of thinking you describe; several of them are arrogant, self-righteous and un-empathetic. I have one patient on 3 psych meds (not prescribed by me) who’s been stable for years who recently talked to me about wanting to slowly taper off one of his three meds, as a trial, with his ultimate goal being to get down to 0-1 psych meds. I thought that was a great idea & completely supported him. He was so hopeful; so proud of how well he was doing. But his psychiatrist is one of the horrid ones and completely squashed the idea when he brought it up with her, basically telling him he’d relapse and wreck his life if he changed his regime. When he came back to see me in primary care he was thoroughly deflated. The light had gone out of him. I don’t want to leave this site and abandon my patients because they need someone who cares for them as people and I feel committed to them. But I’m not sure how long I’ll be able to last in this setting.