American Delirium Society Blog by Dr. James Rudolph

Dr. James Rudolph, MD

Dr. James Rudolph, MD

Hey, here’s a shout-out about a new blog post by Jim Rudolph, MD, on the American Delirium Society (ADS) website:

I commented although I’m reposting it here until ADS site administrators review it.

I like Jim’s outline. I thought of what Suzuki said about experts, though:

“In the beginner’s mind there are many possibilities, but in the expert’s there are few.”—Shunryu Suzuki

I staff a one man hit-and-run psychiatry consult service and, while psychiatrists are often viewed as the delirium experts, I try to teach medical students and residents rotating on the service that, even as beginners, they’re capable of assessing and managing as well as preventing delirium.

Of course, as beginners they are often under the supervision of non-psychiatric faculty who will insist on calling a psychiatric consultant, sometimes when it’s unnecessary. I let them know that, if they stay on at the University of Iowa and they call me under these circumstances—I will understand.

Change is glacial. Sometimes assembling a team entails taking the long view that such an assembly may well take decades.

Jim’s 3rd step is critical. Offering an alternative intervention in the form of self-improvement programs can lead to corresponding improvements in patient care. One of my residents and I recently made a Maintenance of Certification (MOC) Delirium Performance in Practice (PIP) Assessment Tool, which has gained preapproval by the American Board of Psychiatry and Neurology. Prior to this, there were no MOC tools available for this essential skill. As many readers of my blog know ( ), I have a low opinion of MOC as a vehicle for lifelong learning because of that and other limitations of Part IV of the MOC.

Good listening is an art which takes a long time and a lot of patience to develop. I’m not patient, but I’ve learned over the years (often enough the hard way) that Stephen Covey’s habit “Seek First to Understand, Then to be Understood,” is what stakeholders wish leaders would develop.

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