Better Make Way

Jim Amos home made PM handbook 2004 coverOne of the residents currently rotating through the psychiatry consultation service found a relic from my past in a desk drawer yesterday. I had thought all of the copies of my home-made handbook on consultation psychiatry were long gone. But there it was.

Jim Amos home made PM handbook 2004 title page and TOC

It’s probably 9 years or so since I wrote it. It was the precursor to the handbook published by Cambridge University Press, a book that I and Dr. Robert G. Robinson co-edited.

A practical book you can use

A practical book you can use

The psychiatry consult service at The University of Iowa Hospitals and Clinics had its beginnings in the late 1960s . When I was a resident, there were no introductory manuals or guidelines on its educational purpose or what value it gives to the care of patients in the general hospital. The resident found this old manual on a day when I was musing about the forthcoming graduation of another resident who will be interviewing for a fellowship slot in Psychosomatic Medicine. He’ll also be presenting a poster at the annual meeting of the Academy of Psychosomatic Medicine (APM) in Arizona in November.

These kinds of events always trigger that strange triad of pride, loss, and hope for the future which marks the completion of another stage in a learner’s training, in a learner’s life–and which a teacher has the privilege to witness.Jim Amos home made PM handbook 2004 objectives for psyc resid

I feel a bit like a relic myself during these times. Although some may find this hard to believe, I do a little less talking nowadays when the consult service interviews patients in the general hospital. Yes, it’s true; I’m learning to let the learners lead. There is room for the miraculous in life after all.

The process of consultation psychiatry has not changed that much. I re-read some of the chapters and could see the ghost of the old haunting the new places to which Psychosomatic Medicine has traveled.Jim Amos home made PM handbook 2004 chap 2 CL process

I talk less during patient interviews so the learner can become more independent. However, I talk more outside of interviews about the political and regulatory forces that increasingly impinge on medical and psychiatric practice. Maybe I do that because I view trainees as being the wave of the future and I hope they continue to make up their own minds about how medicine ought to be  practiced–and not allow bureaucrats to control it.

I know this geezer will have to make way sometime. I have a lot of faith in the young folks.




  1. Jim – The interface with residents and medical students is always difficult. A little over a decade ago, I found that the documentation and billing requirements were so onerous that teaching in any clinical setting was a living hell. The administration at the time held the opinion that staff had to write notes that paralleled the notes of the resident in order to avoid claims for billing fraud by whatever government agencies chose to prosecute us. Following these instructions was very difficult because the residents lacked autonomy and it made them seem peripheral to patient care. When the tide eventually turned, I found that seeing patients individually on my inpatients service and then discussing them in rounds with the residents was the most efficient way, especially on days when the residents had lectures or other activities off campus. Your current approach greatly enhances both the autonomy of the resident and probably the resident teaching medical students. Your point about bureaucrats is well taken. In the case of billing and coding – it not only lacks an objective basis, but it can clearly interfere with teaching at several levels.


%d bloggers like this: