Featuring Dr. Myleme Ojinga Harrison, MD, President of The Carter Clinic, P.A.
The pressure on American psychiatry has produced a quiet but consequential compression: the brief medication visit. Fifteen minutes, sometimes less. Enough to ask about side effects, check a symptom scale, and renew a script. Not enough to understand what has actually changed in a patient’s life since the last appointment.
Ojinga Harrison MD, a board-certified psychiatrist and president of The Carter Clinic, P.A., has spent nearly three decades arguing against this model. His clinics across Raleigh, Fayetteville, and Smithfield, North Carolina, serve thousands of patients each year, and the operational pressure he describes is familiar to any mental health provider working in the United States today: more demand, fewer clinicians, and institutional systems built around throughput.
His objection is not nostalgic. It is clinical.
What Short Visits Miss
Psychiatric symptoms rarely announce themselves cleanly. A patient who reports that their depression is “better” may be sleeping more because of a medication side effect, not because their mood has lifted. A teenager who says school is “fine” may be masking a pattern of avoidance that will surface months later as a full anxiety disorder. An adult whose irritability looks like mood instability may be experiencing an endocrine problem, a sleep disorder, or the cumulative weight of a caregiving situation at home.
Dr. Myleme Ojinga Harrison has described this in his own writing as the difference between managing symptoms and understanding trajectories. In a fifteen-minute visit, a clinician can manage. In a longer one, structured around context and continuity, a clinician can interpret.
“The practice of psychiatry is not about filling slots. It’s about understanding trajectories.”
The Efficiency Trap
From an administrative perspective, shorter visits look like a win. Variability drops. Scheduling becomes predictable. More patients are seen per clinician per week, and the system’s capacity metrics improve. These are real gains, and Harrison does not dismiss them.
What he challenges is the assumption that those gains carry no cost. The cost, in psychiatry specifically, tends to show up later: premature diagnostic closure, unnecessary medication exposure, patients who cycle through providers because no one is holding the long view of their case, and the slow erosion of a clinician’s own judgment when every encounter is structured around a checklist.
Harrison frames this bluntly. Mental health mistakes do not make their presence known loudly. They work quietly, through wasted years and eroded self-concept, and they often cannot be traced back to any single visit.
What a Longer Visit Actually Produces
At The Carter Clinic, appointment structures are deliberately designed to allow for what Ojinga Harrison MD calls integrative decision-making. Pharmacological decisions take into account the patient’s past trials, their long-term goals, and their current psychosocial context. Therapy, when indicated, is coordinated rather than siloed, drawing on CBT, DBT, motivational interviewing, and psychoeducation depending on the presentation. This integrative approach is part of what clinical observers have described as a replicable model for adolescent psychiatry being used across his twelve-location practice in North Carolina.
This is slower. It also reduces the number of medication switches, the number of missed co-occurring diagnoses, and the number of patients who quietly disengage from care because no one has ever asked them what a good outcome would actually look like in their own life.
A Different Metric for Efficiency
Harrison’s argument is not that psychiatry should be expensive or artisanal. It is that the metric by which efficiency is measured needs to extend beyond the visit itself. A thirty-minute visit that prevents a decade of wrong treatment is more efficient than a seven-minute visit that launches it. A clinician who holds a case for three years produces more value than three clinicians who each hold it for twelve months.
For health systems under pressure to meet adolescent and adult mental health demand, this is an uncomfortable reframing. It suggests that capacity problems cannot be solved purely by compressing visits. It requires leadership willing to protect clinical thinking from the pressure to accelerate.
In a field where the consequences of rushing often surface years after the rushed decision, that protection is not a luxury. It is the work.