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Top Doctors 2010: The Evolution

Medicine keeps moving forward, thanks to practitioners such as these.

(page 4 of 7)

Janis Chester | Psychiatry

Americans are having a tough time these days. Already troubled by our own personal foibles and relationship problems, we also have the added worries of war, terrorism and an economy that seems out to get us—personally. “It’s as if our own insecurities and inner conflicts are writ large in society,” says psychiatrist Janis Chester. “Americans feel like they are being pushed over the edge.”

Chester, chair of the department of psychiatry at Bayhealth Medical Center, has practiced in Delaware since 1998, after she finished a fellowship in geriatric psychiatry at Cornell University Medical Center and directed an inpatient unit at Thomas Jefferson University Hospital. In addition to teaching at Jefferson Medical College, Chester splits her time about 25/75 between caring for institutionalized geriatric patients and counseling patients in her private practice.

As a traditional psychoanalytically oriented psychiatrist, Chester is a bit of a throwback to the mid-20th century, before biologic psychiatry became the prevailing mode. Or maybe she’s ahead of the curve on a return to more traditional approaches that balance the tendency to seek a quick-fix with medications.

“Most psychiatry is still biologically based, but there’s a little push back now,” Chester says. “People are beginning to recognize that even for biologically based illnesses such as panic disorder, psychotherapy combined with medication works better.” Still, the prevailing mode in mental health is what Chester calls “split treatment”: the psychiatrist prescribes the medications and a psychologist, social worker or other counselor provides the therapy.

It’s not that Chester shuns medication. Most of her geriatric patients suffer some sort of dementia, so those treatments are mostly biologically based. And about half of her private practice patients are on psychiatric meds. But Chester prefers traditional psychoanalytic psychotherapy—delving deep into a patient’s past to find the root cause of today’s problems. “Psychotherapy is not a quick fix,” Chester says. “It usually takes three to five years to really resolve the issues.” It’s not something that many patients can or want to pay for, she adds. For those who do? The goal is changing lives.

Page 5: Anthony Sciscione | Maternal Fetal Medicine