Abstract
Sunderj et al. must be commended for daring to call a spade a spade. 1 Indeed, “mediocrity of usual care” is frequent but the scandal is not restricted to patients with mental disorders.
This is a general rule for patients with a chronic disease, including victims of drugs. 2,3 Collaborative care is a prerequisite for effectiveness of multi-factorial lifestyle interventions. Psycho-social interventions are the cornerstones of care: relationships between social determinants, psychosocial factors and health outcomes cannot be overlooked. (https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/640674/20170824_Psychosocial_pathways_and_health_equity.pdf).
Sadly, medicalisation is more and more frequent and the first line, general practitioners, now is a specialist. In the US, family medicine was recognized as a specialty and, in 1971, the American Academy of General Practice changed its name to the American Academy of Family Physicians. In France in 2004, general practice was recognized as a specialty, requiring a specific residency.
The “pinball syndrome” is an urban term for those who suffer from addiction use and describes intoxication to the point of bouncing off the walls. This term could be used to describe uncoordinated care pathways experienced by patients with a chronic disease. They must face either an uncoordinated system or sequential workflow processes where specialisation is the motto, with rotating professionals.
Sunderj et al. provided robust evidence for the effectiveness of collaborative care and highlighted that the system has been hitting rock bottom for too long. Using the term “pinball syndrome” could help to change the mindset.