Try to See It Our Way

I’m an early riser and it’s about 5:30 in the morning. My schedule, such as it is, will be about the same today. I’ll be staffing the psychiatry consultation service for the general hospital, which means I’ll be working with a smart, motivated senior medical student and an outstanding resident putting out fires all over the place.

Because the resident asked me why I always refer to my service as “Hit-and-Run” I told him it’s because we’re short-handed and busy with a lot of questions from our colleagues in medicine and surgery. We often have time enough only to see patients once, quickly at that, show that we care, try to put out the fire–and move on to the next one. I could as well have pointed out the quote from Dr. Thomas P. Hackett, MD, a former Academy of Psychosomatic Medicine (APM) president:

Dr. Thomas P. Hackett Jr., MD“A consultation service is a rescue squad.  At worst, consultation work is nothing more than a brief foray into the territory of another service…the actual intervention is left to the consultee.  Like a volunteer firefighter, a consultant puts out the blaze and then returns home… (However), a liaison service requires manpower, money, and motivation.  Sufficient personnel are necessary to allow the psychiatric consultant time to perform services other than simply interviewing troublesome patients in the area assigned to him.”—Dr. Thomas Hackett.

This will make it challenging and probably all but impossible for me to be in my office this afternoon if the Executive Director of the Iowa Board of Medicine (IBM) calls to discuss what is happening with the Maintenance of Licensure (MOL) implementation project items on the agenda at the IBM meeting today in Des Moines. Recall from a previous post what’s at stake. Will we be able to work things out so that physicians who hate the very idea of Maintenance of Certification (MOC) and MOL and the boards can agree on the most effective and least burdensome way to encourage the cultivation of a love for and dedication to lifelong learning into the culture of medicine?

I see that there’s a conflict on my schedule. I’m also supposed to be at a meeting of the Delirium Early Detection and Prevention Committee today at the same time. I think of all the consult questions we still get from doctors about delirium and wonder–will we ever work it out so that they can recognize and manage delirium more or less on their own, at least initially?

I’ll probably miss both meetings. But I hope we can work it out.



  1. How’d it go?


    • I made it to both meetings. I’ll have more to say in a post tomorrow, but the Executive Director of the Iowa Board of Medicine and I talked for over half an hour. I thought it went well.


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