New Mindfulness Programs: A Letter from Bev

“Mindfulness is simply being aware of what is happening right now without wishing it were different; 

enjoying the pleasant without holding on when it changes (which it will); 

being with the unpleasant without fearing it will always be this way (which it won’t).”

– James Baraz, mindfulness teacher & author

Bev Klug
Bev Klug


I hope you are enjoying this day. Below you’ll find a new resource, our new Winter/Spring Mindfulness Programs with descriptions and registration information as well as upcoming retreat information. We also have a new web address so please put us in your “favorites” and double-check listings there in case of changes or to share with others.

A New Resource Click here for a video (or see below, JA) we’ve come across that is a lovely refresher of Jon Kabat-Zinn’s mindful attitudes that are so helpful in our practice and in daily living. He has even added a couple of new ones!

Mindfulness-Based Stress Reduction (MBSR)   

This 8-week program assists people who want to learn to use their own internal resources to respond more skillfully to stress, medical and psychological conditions and to promote healthy living. Please share the information with people whom you think might benefit. Everyone is welcome whether or not they are a UI employee. UI employees may be eligible for full fee support through UI Wellness. They need to meet employment criteria, fill out the Personal Health Assessment at and schedule an appointment with a health coach. Currently registered UI students receive a 50% discount on the fee. Non-UI employees who are highly motivated to participate, but have severely limited financial resources, may request a scholarship application. Options for the required informational sessions are listed on the flyer below. See for more details.


Mindfulness-Based Cognitive Therapy (MBCT)

MBCT is a program that integrates mindfulness meditation and cognitive therapy. Scientific research supports that it is effective, when practiced consistently, for prevention of depression relapse and, for some, reduced use or elimination of anti-depressant medication. It can also be helpful in relating skillfully to anxiety.  People who have had episodes of depression must be currently in at least partial remission in order to participate. The group is similar in structure and format to the MBSR program, with more focus on being aware of cognitive, emotional and behavioral patterns that contribute to depression relapse and/or escalation of anxiety and using the practice of mindfulness to respond more skillfully. MBCT and the required intake session are paid for by most insurance plans with mental health and group therapy coverage. Participants must have a diagnosis of depression and/or anxiety. You can participate in this program even if you have completed MBSR and, in fact, many people find it useful to do so if they experience chronic depression and/or anxiety. Contact Tess or Keely at or 319-384-5089to schedule an intake session. See flyer below for details also. Instructor is Bev Klug, M.A., LMFT.


Graduate Groups

The groups below are open to people who have completed one of our 8-week programs at University of Iowa Hospitals and Clinics, Carver College of Medicine or University of Iowa (academic courses). UI employees with flex spending accounts may be reimbursed for the fees. Many people find that the graduate groups help them return to more consistent practice, deepen what they are already doing, and/or benefit from practicing and discussing mindfulness with others.

1)  Spaces

What makes a fire burn is space between the logs, a breathing space…             From “Fire” by Judy Brown

The beginning of a new calendar year often elicits resolutions and intentions for healthier living.  These good ideas, without practice, may quickly fall away as busyness and old habits exert their force.  In this group, we’ll focus on brief and extended mindfulness practices that support us in both creating spaces in our lives and being aware of those that are always here.  For example, the space between impulse and action when awareness may help us make a conscious, skillful choice instead of engage in an automatic reaction that isn’t congruent with our intentions.

Schedule: Tuesdays, January 10 – February 7, 2017  (5 classes)                      Registration Deadline:  January 5, 2017

Time:  5:30-6:30 PM

Fee:  $90 (Pay at first class – may be reimbursed by UI flex spending)

Location:  UI Hospitals and Clinics

Instructor:  Chris Klug, M.A.

Registration: Email and we will send you specific directions and confirmation of your registration.

Note: Mindfulness programs are fee-for-service and viability of a group is based on enrollment, as is the specific location. Please check your schedule carefully before registering.


2)  Mindful Parenting

An important part of mindful parenting “is seeing ourselves with some degree of kindness and compassion. This includes seeing and accepting our limitations, our blindnesses, our humanness and fallibility, and working with them mindfully as best we can.”    -Jon and Myla Kabat-Zinn, Everyday Blessings: The Inner Work of Mindful Parenting

Do you find yourself wishing you could truly be with your children more often, instead of feeling distracted and divided? When under stress, would you like to be more responsive and less reactive with your children? Could you benefit from cultivating greater compassion and acceptance for yourself and your family? This group will apply the fundamental attitudes of mindful awareness to our relationship with our closest observers and most beloved critics: our children. Topics will be tailored to the interests of the group as we share the full catastrophe that is mindful parenting. Class time will include sitting meditation, discussion and suggestions for mindful parenting practices throughout  week, with email support between classes.

Schedule: Wednesdays, January 25-February 22, 2017  (5 classes)

Registration Deadline:  January 19, 2017

Time:  6:00-7:00 PM

Fee:  $90 (Pay at first class – may be reimbursed by UI flex spending)

Location:  UI Hospitals and Clinics

Instructor:  Kerri Eness-Potter, M.A.

Registration: Email and we will send you specific directions and confirmation of your registration.

Note: Mindfulness programs are fee-for-service and viability of a group is based on enrollment, as is the specific location. Please check your schedule carefully before registering.


3)  Practicing Kindness and Compassion

Meditation requires patience and lovingkindness. If the process of clear seeing isn’t based on self-compassion it will become a process of self-aggression. We need self-compassion to stabilize our minds, to work with our emotions, to stay…  -Pema Chödrön

Mindfulness practice is one of paying attention intentionally with attitudes such as non-judging, patience, and compassion as we hold our experiences in awareness. Lovingkindness meditation is a practice of intentionally nurturing these attitudes toward ourselves and others, while still acknowledging the truth of our experience. It can be useful in developing our ability to bring compassion and kindness to self-criticism, as well as judgment of others.

In this practice many people experience a sense of openness, freedom and satisfaction as well as the opportunity to work gently with feelings of anger and sadness. As is always true in the Mindfulness practice, we will work with responding to what arises in each moment, rather than trying to make something in particular happen. Class time will include sitting meditation, and suggestions for practice between sessions will be given.

Schedule: Mondays, March 27 – April 24, 2017 (5 classes)                                                        Registration Deadline: Monday, March 20, 2017

Time:  Noon – 1:00 PM

Fee:  $90  (Pay at first class – may be reimbursed by UI flex spending)

Location:  UI Hospitals & Clinics

Instructor: Kerri Eness-Potter, M.A.

Registration:  Email and we will send you specific directions and confirmation of your registration.

Note: Mindfulness programs are fee-for-service and viability of a group is based on enrollment, as is the specific location. Please check your schedule carefully before registering.


4) Living Mindfully with Chronic Medical Conditions

Being present with and accepting of current-moment experiences can be challenging, even in times of ease.  Living with a chronic medical condition/s can add layers of challenge to this intention through physical discomfort; worries about the future and possible progression of the illness; fear of the unknown; past and current losses; the inevitable, unpredictably appearing, not new but somehow still unexpected (!) symptoms associated – or new symptoms unassociated – with progressive diseases; and dealing with days of essentially feeling “undone” for some time.  Because these conditions aren’t always visible to others and the person experiencing them may be going about their life working, parenting, etc., even while hurting or feeling sick, it’s common for the suffering they experience to go unacknowledgedor misunderstood by others, thus contributing to them feeling or becoming isolated.  When the condition flares periodically, the ensuing limitations may impact their ability to work, maintain social and familial relationships, while also creating uncertainty and possible losses. The practice of mindfulness – opening to what is here with compassion,  kindness and wise discernment, can serve as a trusted guide in living as fully as possible, even with this.  Let’s explore together and see what your experience is.
The format of this group will be a combination of practice, reading and discussion. There are some mindfulness-based books and other resources written by people who live with chronic conditions that we will draw from, including a variety of practices.

This group is appropriate for people who want to address, through the lens of mindfulness, some of the challenges associated with chronic medical conditions that are not predicted to substantially improve, including, but not limited to:  Inflammatory Bowel Disease (IBD); Multiple Sclerosis (MS); fibromyalgia; Systemic Exertion Intolerance Disease (formerly Chronic Fatigue Syndrome); chronic pain; cancer; autoimmuneand other inflammatory illnesses and/or medical symptoms that are unexplainable.

Schedule: Monday, April 3 – May 1 (no class April 17), 2017    (4 classes)                     Registration Deadline:  March 27, 2017

Time: 5:30-6:30PM 

Fee:  $75

Location: UI Hospitals and Clinics

Instructor:  Bev Klug, M.A., LMFT

Registration: Email and we will send you specific directions and confirmation of your registration.

Note: Mindfulness programs are fee-for-service and viability of a group is based on enrollment, as is the specific location. Please check your schedule carefully before registering.


Anyone who has completed an 8-week MBSR, MBCT, UI Undergraduate, Psychiatry Residency or teen group is welcome to attend an extended retreat. There is no fee but donations to the scholarship program are encouraged. Please email for location details as they are not all held in the same place. Upcoming retreats will be Saturday from 9:00 am-3:30 pm on the following dates:

November 5, 2016

February 25, 2017

April 1, 2017

April 29, 2017


Please let us know if you have suggestions for other programs that could support you in your practice of mindfulness.

Wishing you well,


Bev Klug, M.A., LMFT

Director of Mindfulness-Based Programs

Department of Psychiatry, UIHC

200 Hawkins Dr. /1911 JPP

Iowa City, IA  52242

Neuroscience Unchained or How to Make Play-Doh Brains

I just saw a post by Dr. George Dawson that made me think about neuroscience differently. He mentioned the National Neuroscience Curriculum Initiative (NNCI). I sometimes make fun of neuroscience, but it turns out the joke is on me because the people at NNCI make a pretty decent case for neuroscience being teachable and practical.

They teach you how to make brains out of Play-Doh..among other things.

Maybe it’s just because my blog site is usually pretty cluttered, but I think the NNCI web site is outstanding. The layout reminds me of the templates on the SquareSpace site, about which Psych Practice recently posted. Anything that clean and so easily navigable rates attention.

I suggest starting with the video at the bottom of the home page; it’s only  about 20 minutes long.

By the way, George mentioned  Melissa Arbuckle, MD, PhD; Professor of Clinical Psychiatry, Director of Residency Training; Department of Psychiatry, Columbia University Medical Center. She gave the presentation he attended at the University of Wisconsin 4th Annual Update and Advances In Psychiatry – a conference that has been held for the last 41 years. Her talk impressed him.

It turns out she’ll  be presenting at next month’s Academy of Psychosomatic Medicine (APM) annual meeting in Austin, Texas, for which the theme is “Brain, Mind and Body: Why Every PM Psychiatrist Should Care About Neuroscience.” The title of her 4 hour talk on 11/9/2016 8 AM-noon is “The National Neuroscience Curriculum Initiative: Bringing Neuroscience Into the Clinical Practice of Psychiatry.”

Here’s what the NNCI web site says about Translational Neuroscience:

The overarching goal of the translational neuroscience course is to enhance residents’ attitudes towards neuroscience and its applications towards clinical psychiatry.

The supplementary articles chosen for this course demonstrate how current neuroscience work could change the way we think about treating our patients in the future. Through this learning module we are able to think about what’s interesting & exciting about neuroscience and what could have the potential to change the field. As with many of the articles/ideas we will review during the course, the majority will probably not pan out — that’s okay. The goal is to think about the ways in which current neuroscience has the potential to reshape our field.

A lot of what they say “will probably not pan out.” How’s that for frankness without hubris? And I really like the title on the home page:

Integrating A Modern Neuroscience Perspective


I didn’t know Play-Doh could be so practical.

Hats Off to Luisella Magnani for Poster for Hats On for Children’s Palliative Care

Because I’ve been on vacation most of this month, I’m well over a week late getting this poster out from Dr. Luisella Magnani for the Hats on for Children’s Palliative Care observance on October 14, 2016. This was to raise awareness of “the rights of very sick children with incurable and life-threatening illnesses to receive palliative care.” Luisella teaches linguistics and aesthetics at the University Institute in Science of Linguistic Mediation of Varese, Italy. She is a researcher of Aesthetics at the Catholic University of Milan. Her affiliation is with the University of Studies of Insubria of Varese. She is focusing on prenatal pain in babies within the field of the non-pharmacological Care. Last May, Luisella received the Advocacy for Italy, for Paediatric Palliative Care from the International Children’s Palliative Care Network.


Although I didn’t exactly wear a hat on the 14th, I did wear a raincoat with a hood. I hope that counts.

Raining In Seattle And That’s OK

Seattle umbrellaWe just got back from our vacation trip to Seattle, which is Pacific Northwest native american dialect for “land of the broken umbrella.” It rained a lot but that didn’t stop us. We put around 25 miles in on the pedometer over the week we were there. We flew first class for the first time ever, if you can believe it. It was great to be able to cross my legs and the in-flight meal was tasty.Airplane first class meal

Seattle is a city of contrasts. On the one hand, the city is growing as people move there in droves seeking economic opportunity. On the other, homelessness is a serious challenge. On our arrival, the cab driver’s radio announced the shooting of a homeless man who was involved in a fight with another in one of the many tent cities there, a place called The Jungle, one of several targets of a “sweep,” an effort to reduce the size and number of large homeless camps which can become dangerous areas.

However, most of the homeless were more tragic than dangerous. Many have chronic, severe mental illness and one of them even apologized to us after asking for spare change.

A City Council meeting recently ran very long and was the scene of  loud conflict between what are usually liberal Seattleites and those who are struggling to maintain a balance between raising taxes and caring about the homeless population.

That said, you can almost feel their restless vitality and we found them to be almost universally friendly and helpful. We can’t recall anyone being the least bit snotty, of which you’ll sometimes hear them being criticized.

Sena and Jim at Thompson Seattle HotelWe stayed at the Thompson Seattle. Uniformly, the staff there went out of their way to make us comfortable. One of the servers even paid for our breakfast one morning after it was a little slow in getting to our table.

Pike Place Fish CoI was eager to get a short video of one of the Pike Place Fish Co. fish-throwing fests. While I was fumbling with my camera, one of the workers and my wife, Sena, stood there and looked at each other for a few seconds. Then Sena asked simply, “When’s it gonna happen?” He says, “Tell your husband to get his camera ready and we’ll get it going!”

It happened! Afterward, the guy said this would be more fun if people bought something. I wanted to but didn’t have a place to keep raw salmon in our hotel room.

Snoqualmie Falls Park signThe trips to Snoqualmie Falls and Mt. Rainier National Park were neck and neck for favorite attractions. Terry Divyak, the owner of Shutter Tours, was one of the nicest tour guides we’ve ever met. He didn’t even lose his temper after discovering he’d been given a parking ticket while he was greeting us at Pike Place Market. Terry is an expert photographer and gave us some tips on how to get the best shots.

He’s the one who took the best pictures of me and Sena at the falls and at Kerry Park, sometimes known as Post Card Park. One of the first questions he asked our group was whether or not we’d had a chance to see the Gum Wall yet. This was a surprise because Sena had pressed me to Sena and Jim at the Gum Wallget directions on one of my smartphone apps to the Gum Wall although we probably would never have found it if she hadn’t asked somebody for directions, who was very happy to oblige. Terry also took us to see the Fremont Troll, which is a huge sculpture of a troll clutching a volkswagen and who has a hubcap for a left eye. He lives under a bridge.Fremont troll

Terry also told us a tidbit about Howard Schultz, a former employee of Starbucks back in the day before they ever sold coffee by the cup. Howard later became a multimillionaire as a Starbucks tycoon. Howard got an epiphany about selling coffee by the drink while he was in Italy, visiting a coffee emporium. It struck him after a few cups of espresso. I wonder if it was the caffeine.

Joe was our leader on the all day tour of Mt. Rainier National Park. He was generous enough to buy a big cake as well as cupcakes for everyone to celebrate both a birthday and an anniversary for members in our small group. He never tied his shoes and almost never stopped talking. He had an uncanny sense of timing for exactly when to arrive at a street crossing for a photo op of the Mt. Rainier Scenic Railroad steam engine train passing whistling through, a cloud of steam in its wake.

Starbucks on PikeSeattle is known, of course, for coffee and seafood. There’s a lot more to coffee there than Starbucks, although it has a rich history in the city. We saw many small places that vie for the traveler’s attention including an unpretentious and very friendly place called Seattle Coffee Works. There was even a small note on the bulletin board saying “We’re not snotty.”Seattle Coffee Works free drink card

Star Trek at Seattle CenterWe saw a lot of sights, including the Experience Music Project Museum at the Seattle Center, which included exhibits about musicians especially from Seattle, such as Kurt Cobain and Jimi Hendrix as well as one about the Star Trek TV series, which ran from 1966 to 1969 and which was, in part, a vehicle for Gene Roddenberry’s vision of the future for humanity, which included promoting civility, restraint, justice, freedom, acceptance of others who are different from us, mercy, and other qualities which appear to be lost on certain political candidates these days. No, I’m not watching the 3rd episode of “My So-Called Debates.”

Seattle doesn’t get as much rain as a lot of places although it sure seems like it does. Despite that, nobody there wastes any time complaining about it.

Stop Debating Competence and Foster A Culture of Excellence

Before the news gets too cold, I’d like to point out two excellent articles on Maintenance of Certification (MOC) for the trainees. One of them is a cross-specialty national survey of physician attitudes toward MOC recently published in the October issue of Mayo Clinic Proceedings. The video below encapsulates the findings.

Along with that is a first person article by a doctor undergoing the board recertification examination. You really need to read both to get a clear idea of the history of MOC and the positions taken on it by the boards and rank and file doctors. The real issue for me is whether our profession chooses to settle for “competence” or pursues building a culture of excellence.

I take issue with Cook, et al when they claim “…evidence confirms that physicians cannot self-assess their learning needs.” I think I know pretty well when I need to check the medical literature when I encounter an issue in my field I need to know more about. My opinion about this is well known to all who know me and read my blog. I’ve even been pretty frank about with the American Board of Psychiatry and Neurology (ABPN). I think Part IV of MOC should be rescinded altogether although the ABPN recently notified me and one of the residents that our Delirium Clinical Module was finally approved for MOC credit. However, you’d have a pretty challenging time finding the link by trying to navigate from the ABPN home page URL.

Go ahead, I double dog dare you.

That’s why I’ve put a link to it on my own blog home page. And I suspect that the incentive for using it might be lukewarm now that the ABPN has changed the rules about the clinical module requirement. While they haven’t actually gotten rid of Part IV, they almost have. No one who doesn’t want to work on the PIP Clinical Module actually has to because they can substitute a Feedback Module. Most front line doctors don’t have time to fiddle with the PIP Clinical Modules on the ABPN MOC web site because so many of us are subspecialized it’s virtually impossible to find one which would be meaningful and worth taking time away from our practice for. That’s why we call the PIP Clinical Modules “busywork.” The Delirium Clinical Module is pertinent but why would anyone bother now?

The ABPN technically doesn’t violate the American Board of Medical Specialties (ABMS) insistence on retaining Part IV because Part IV itself remains intact. On the other hand, psychiatrists are probably getting a break from the burdensome and wasteful PIP Clinical Module because, while Part IV is not optional–the PIP Clinical Module is.

Furthermore, I think that our own Clinical Problems in Consultation Psychiatry (CPCP) and our new Psychosomatic Medicine Interest Group (PMIG) case conferences are better ways to implement the principle of lifelong learning than the MOC Part IV or so-called clinical modules. The trainees do excellent work in both. In my opinion, fostering the pursuit of excellence is far more important than settling for competence, which the MOC does a poor job of supporting in any case.

The Cook, et al paper and Dr. Ofri’s piece send fundamentally the same message, which is that the MOC processes are too flawed to accomplish what the boards claim they do–support the principle of lifelong learning. I agree that rank and file physicians and boards would do well to stop the endless debate about the pros and cons of the present form of MOC, agree to scrap the low bar of “competence” and start earnest and honest collaboration on how to support the efforts of doctors in their worthwhile though unsung search for a culture of clinical excellence.


Cook, D. A., et al. (2016). “Physician Attitudes About Maintenance of Certification: A Cross-Specialty National Survey.” Mayo Clin Proc 91(10): 1336-1345.
OBJECTIVES: To determine physicians’ perceptions of current maintenance of certification (MOC) activities and to explore how perceptions vary across specialties, practice characteristics, and physician characteristics, including burnout. PATIENTS AND METHODS: We conducted an Internet and paper survey among a national cross-specialty random sample of licensed US physicians from September 23, 2015, through April 18, 2016. The questionnaire included 13 MOC items, 2 burnout items, and demographic variables. RESULTS: Of 4583 potential respondents, we received 988 responses (response rate 21.6%) closely reflecting the distribution of US physician specialties. Twenty-four percent of physicians (200 of 842) agreed that MOC activities are relevant to their patients, and 15% (122 of 824) felt they are worth the time and effort. Although 27% (223 of 834) perceived adequate support for MOC activities, only 12% (101 of 832) perceived that they are well-integrated in their daily routine and 81% (673 of 835) believed they are a burden. Nine percent (76 of 834) believed that patients care about their MOC status. Forty percent or fewer agreed that various MOC activities contribute to their professional development. Attitudes varied statistically significantly (P<.001) across specialties, but reflected low perceived relevance and value in nearly all specialties. Thirty-eight percent of respondents met criteria for being burned out. We found no association of attitudes toward MOC with burnout, certification status, practice size, rural or urban practice location, compensation model, or time since completion of training. CONCLUSION: Dissatisfaction with current MOC programs is pervasive and not localized to specific sectors or specialties. Unresolved negative perceptions will impede optimal physician engagement in MOC.

Reflections On The Political Debate

As we reflected on the recent Presidential and Vice Presidential televised debates and anticipate the next one this Sunday, my wife mentioned an Independent Lens program called Best of Enemies she found out about as she was flipping through the TV channels, stopping briefly on the Public Broadcasting Service (PBS). The link in the previous sentence will get you to the full length film only until November 3, 2016, although it will probably be re-broadcast periodically in the future. As the blurb says, the “Legendary nationally televised debates in 1968 between two great public intellectuals, Gore Vidal and William F. Buckley, defined a new era of public discourse in the media, the moment TV’s political ambition shifted from narrative to spectacle.” It goes on to say:

“In the summer of 1968, television news changed forever. That year, gunmen assassinated both Robert Kennedy and Martin Luther King, Jr. The Democratic convention in Chicago flared up with protests and violence. Overseas, the Vietnam War raged on, and the streets at home roiled with race riots. With this tense political climate as a backdrop, Best of Enemies captures the legendary televised debates between ideological opposites Gore Vidal and William F. Buckley, Jr.

Dead last in the ratings, ABC hired Vidal and Buckley to debate each other during the Democratic and Republican national conventions. Buckley, who founded National Review magazine in 1955, was a leading light of the new conservative movement. Gore Vidal, lifelong Democrat and cousin to Jackie Onassis, was a leftist, taboo-smashing novelist and polemicist. Both believed each other’s political ideologies were dangerous for America. Like rounds in a heavyweight boxing bout, they pummeled each other with exchanges that devolved into personal attacks. These live and unscripted quarrels riveted viewers, and the television industry took notice.

Best of Enemies reveals the moment TV’s political ambition shifted from narrative to spectacle, forever altering the way the media — and Americans — talked about politics.”

I watched the film and was struck by the great similarity to the current debates being broadcast, meaning the lack of civility and, at it’s apex, the astonishing open hostility which eventually led to disastrous wounds to their souls and which may have provoked Buckley to say in his later years that he was tired of living on. The poem “The Snow Man” by Wallace Stevens aptly fits what ultimately happened to both men.

Of course, I was too young at the time to even watch the show, much less understand what was going on both in the real world and on TV. However, it should be obvious to everyone why this video is being aired now. The language in the current debates, while they are much less intellectualized, are hardly less hostile and this Sunday’s upcoming debate threatens to air ad hominem attacks which will echo the Vidal-Buckley war. For the debaters’ sake, I hope it doesn’t turn out that way.

Just before I went on vacation, I got on a soapbox myself and speechified to the residents and medical students about the parallels between the political debates and difficult conversations doctors can have with one another. This can become especially troubling between psychiatric consultants and consultees in the general hospital. In microcosm, physicians can argue about patient care, medical knowledge, and the rest of the core competency pizza:


In macrocosm, world wars, terrorism, and other conflicts can arise. But in my opinion the hub is the Interpersonal & Communication Skills competency. A psychiatric consultant needs to be able to clarify consultation questions and convey recommendations in a diplomatic, even statesman-like way. Some might say that’s just being political but I think many of us would tend to distinguish between a statesman and a politician. I couldn’t find out much on line about this other than gender discriminatory essays and over-simplified dictionary definitions.

I think it’s a lot like trying to define another competency, Professionalism. It’s difficult enough that some experts say it’s almost impossible. Statesmanship is more like an aspirational goal of most politicians, the vast majority of whom we criticize, lampoon, and deplore generally. Claiming that you’re not from the ranks of the polished politicians doesn’t seem to save you.

We might try to get around the challenge of defining Professionalism and Statesmanship by claiming they are much less about nuts and bolts detail management and gamesmanship and more about wisdom, meaning skill and experience in principle adherence, conflict management and consensus building. However, in the real world I suspect some gamesmanship is almost unavoidable where the regulatory landscape, systems complexities, and cultural nuances are often bewildering.

I recently noticed that the resident lecture schedule contained a talk called “How to Do a Consultation.” I’ve never seen a presentation titled that way. It made me wonder if I could even put one together using the over-used PowerPoint format to which most lectures are reduced. How would I “do a consult?” There are books and book chapters written about it which describe the nuts and bolts in lumper or splitter terms.

This slideshow requires JavaScript.

dr-jim-amos-fireman-copyBut I’m unsure of my ability to boil the psychiatric consultation process down to a nuts and bolts approach distilled into PowerPoint slides. The best way to learn how to do a psychiatric consult might be to just ride along with the fire brigade consult service on any given day putting out fires around the hospital.

You could debate that–or argue about if you like. You could spend a long time, though, looking for a good role model for debating. I remember my one and only college debate while I was an undergraduate at Huston Tillotson College (now Huston Tillotson University), ruefully if I think about it too long. I still remember his name although I’m not going to mention it. The debate issue was whether or not capital punishment deters crime or something like that; it was way back in the mid-1970s. I lost miserably and it’s easy to say why without sounding like I’m making excuses–my opponent was simply too bombastic for me to get a word in edgewise, abetted by my trying to rebut every statement he made. This prompted good advice from one of my best teachers, Dr. Hector Grant, which was “Never be afraid to concede a point.”

Dr. Hector Grant
Dr. Hector Grant

Hillotson Tillotson news clip about Jim Amos 1976






habari-gani-coverhabari-gani-pg-dr-porter-sponsorThis also reminds me of another great teacher, Dr. Jenny Lind Porter. Sadly, her house, Casa Magni, is slated for demolition. However, I was pleasantly surprised to hear from the architect and Project Designer, who invited me to participate in putting together a remembrance of my former teacher in her honor in the neighborhood where in the next several months, ground-breaking will begin for the new house the style of which will echo that of Casa Magni, along with a micro library and other items.

I hope to include a pdf of one book which I’d been trying to track down for a while now. It’s a book of poems by Huston Tillotson College published in 1975 called “Habari Gani (what’s going on)” and which was sponsored by Dr. Porter. One of the archivists at HT was kind enough to help me get a pdf copy of it. There may be only two copies of the actual book extant, the other at the Austin Public Library. One of the poems probably bears on the debate vs argument distinction [1]. It was written by Charles Osby who, sadly, died about 3 years ago. Although small of physical stature, he had a great soul. May it be that something of his spirit burns in me.

Brother, Brother!

Why do you argue with me, my brother?

You say one thing and I say another.

I don’t wish to argue,

Not with you.

I want to share ideals and brotherly love,

I want to learn and benefit from your mind,

Your mind, like a light that burns on and on,

Constantly searching.

My brother, I do not wish to harm you–

You’re as much a man as I am.

I trust you,

We must trust one another.

Brother, Brother!

We must love one another–

A common bond,

Not to be broken by any force.

We must inspire our services to God,

See and understand,

And learn from what we experience.

That’s all that really matters–

That we benefit from what we have learned.

–Charles Osby


1.Habari Gani (what’s going on): a creative writing publication, 1975, Huston-Tillotson University Archives, Downs-Jones Library, Huston-Tillotson University, Austin, TX. (Charles Osby’s poem “Brother, Brother” reprinted by permission from HT Downs Jones Library Archivist).

CPCP: Antidepressant Use in Heart Failure by Pharmacy Student Christie Hart

Christie Hart pharmacist

We had an outstanding Clinical Problems in Consultation Psychiatry (CPCP) on heart failure and antidepressants today by Christie Hart, 2nd year psychiatric pharmacy resident. In fact, it’s one of the absolute best in recent memory because it exemplifies the importance of all of the core competencies, not just Practice-Based Learning and Self improvement.

The Consultation-Liaison Psychiatrist typically encounters the Core Competency Pizza while running all over the hospital trying to put out all kinds of fires.

Core Competency Pizza
Core Competency Pizza

The CPCP is a case conference and for obvious reasons I could not show all of Christie’s slides because of the obligation to protect the patient’s privacy. However, I can tell you that the question of the safety and efficacy of antidepressants in patients with medical illness crops up all the time. All of the competencies are in play in this arena and Communication and Interpersonal Skills are critically important. Without it we wouldn’t get much done in the hospital or in any other area of clinical medicine or research.

I was a little surprised to learn that the literature is mixed on both the safety and efficacy of antidepressants in the depressed patient with heart failure. Access to mental health care is difficult and sometimes it seems that all psychiatrists have to offer are pills. Psychotherapy can be very effective but it’s even harder to access psychotherapists who offer evidence-based therapies. More often than not, both medication and psychotherapy may be necessary.

On the other hand, in the case of antidepressants and heart failure, it might be wise to exercise more caution in prescribing medication. That does not mean they are never indicated.

Mark Zimmerman, MD Psychiatrist Psychiatry Rhode Island Hospital 2014 Zimmerman. Mark MD 2014
Mark Zimmerman, MD
Rhode Island Hospital
Zimmerman. Mark MD 2014

In fact, many psychiatrists may harbor beliefs about antidepressants that might be wrong. This was highlighted in an article published in the Psych Congress Network article “Diagnosing and Treating Depression: What You Think You Know Might Not Be True” by Eileen Koutnik-Fotopoulos who interviewed Dr. Mark Zimmerman, MD, who is the Director of Outpatient Psychiatry and Partial Hospital Program at Rhode Island Hospital in Providence. Dr. Zimmerman is also Professor of Psychiatry and Human Behavior at The Warren Alpert Medical  School of Brown University, Providence, Rhode Island. I’ll paraphrase a few excerpts and hope to goodness what I share constitutes fair use:

Q-What are some of the beliefs that clinicians may have regarding the treatment and management of depression?

A-The literature is limited regarding the generalizability of research to clinical practice on the efficacy of antidepressants. Study methodologies have inclusion restrictions and other limitations that lead clinicians to think the results may apply to their patients but we really don’t know if that is the case.

Q-What does the literature say about the beliefs clinicians may have about the diagnosis and treatment of depression?

A-It’s hard to show that medication is effective. “Only half the studies comparing medication to placebo find that medication is significantly better than placebo.” Patients who have comorbid conditions with Major Depression and whose severity of depression doesn’t meet the inclusion criterion are often excluded from studies. This can have a big impact on whether patients in real world clinical practice may respond to medication treatment.

Q-How much do clinicians really know about the efficacy of antidepressant medication in treating patients routinely seen in clinical practice?

A-It’s hard to tell if medication is the effective agent or nonspecific elements like the doctor’s bedside manner. And some clinicians may misinterpret the results of a well-known study like the STAR*D, which was thought to be more generalizable to the typical clinic patient. However, it didn’t include a placebo control group. That doesn’t mean people didn’t get better. But when we talk about whether or not antidepressants work, we usually mean whether they work better than placebo.

Dr. Zimmerman’s remarks clearly apply to diagnosing and treating depression in the medically ill. Christie pointed out these issues in the studies in today’s CPCP.

It’s important to have an informed consent discussion with patients and families about the risks and benefits of all psychiatric treatments. And we all need to remember that careful diagnosis before treatment is the correct order of business. Just like everything else in life…we can’t always get we want.

In order to see the picture galleries of photos or powerpoint slides, click on one of the slides, which will open up the presentation to fill the screen. Use the arrow buttons to scroll left and right through the slides or up and down to view the annotations.