Written 22 June 2026 while staying in the psychiatric ward
at 1425 Madison Avenue, Room No. L566.

First typed 28 June 2026, retyped 28 July 2026.

Written for Dr. Stewart Levine and the management of Mount Sinai Hospital;
and, more broadly, for every psych ward in the USA.

In this essay, I employ three key binaries, as follows:

Some notes on the binaries: (1) the first binary covers both sides of psychiatric care. Nurses care whereas doctors treat. To care is human, whereas to treat is licensed and sanctioned. (3) Nurses support whereas doctors attend.

AMPLIFYING (1):

The central question is whether to value individual health (corresponds to the free market) versus collective hygeine (corresponds to socialism).

The economic underpinnings beneath the surface of (1) are no accident.

Definition: Concierge Medicine. A tier of clinical care wherein the roles of doctor and nurse converge. The concierge doctor wields their experience and expertise at the frequency and attention level of a nurse.

CLAIM:

Through the lens of retrospect, every public benefit is, in essence, a facility begotten from an amenity, thence redistributed, originally reserved exclusively for the convenience and ease of the elite class of society. Moreover, shared (and not "common") wealth of society grows when this redistribution is conducted via equity sans charity, compassion sans remorse.

A DILEMMA:

The division of labor specified via (2) and (3) buckles under stress, and caves under sufficient pressure. The response therein forces the system into defaulting onto one half of (1), picking either mental or behavioral health (but not both!), even though both are necessary, dare i say sine qua non, in the aim to honor that oath of Hippocrates, the one that says, in so many words, to:

A HYPOTHETICAL:

What if everyone in New York City, from the ragged vagrant, to the sacred secretary, to the OCD CPA, to the complacent cop, to the fiery philanthropist, to the magnanimous mayor Mamdani himself — what if all had equal access to immediate and tangible paragon tier psychiatric concierge medicine?

The ideal I envision is not as far removed from the bedrock of reality as one might imagine. Via LLMs and reinforcement learning AI, the workload and docket of the clinical team may be distilled, thus allowing the team to focus on what truly warrants their attention, and by extension, their credential and license.

Understaffed hospitals would indeed benefit from serving only those patients who truly need to be in their custody. This is merely triage applied to inpatient intake.

A PROPOSAL:

Suppose Mount Sinai Hospital were to introduce a new credential,

or "psychiatric treatment concierge."

Tantamount to low-level doctors who orbit the ward at nurse-like frequencies, any nurse desiring a pay raise ought to be fast tracked into this credential, should they relish the opportunity.

CONCLUDING:

Psychiatric medicine boils down to a trolley problem. The binaries in question determine whether the team is a team of caretakers, or a team of corrections officers, their primary concern either the safety of the patient or the security of the patient. One door locks from within, the other without.

Which would you choose, and why?