Choosing Our Words Carefully

Well, I’ll be heading to New Orleans tomorrow for the Academy of Psychosomatic Medicine (APM) Annual Meeting; this year’s theme is “The Art and Science of Communication in Psychosomatic Medicine.” It was fitting this morning that I discovered Dr.Laurie Gordon’s blog post “Watch Your Words.” We all need to choose our words carefully.

Communication is one of the core competencies in the Core Competency Pizza, as you’ll recall:

Core Competency Pizza
Core Competency Pizza

Communication underlies all the other competencies, in my view. None of them would be understandable without the basic skill of conveying what we mean in terms that clarify rather than cloud, guide rather than mislead, encourage rather than disappoint, and inspire rather than frustrate.

I don’t have to look very far to find real world examples. Take Iowa Governor Branstad–please! He closed two of the state’s Mental Health Institutes (MHIs), which prompted Democratic legislators and the state employees’ union to sue him. A judge ruled last Tuesday that he had the authority to veto millions of dollars legislators requested to spend on keeping the Clarinda and Mount Pleasant MHIs open [1].

The judge also made it clear that his opinion didn’t necessarily imply that he agrees with Branstad’s action. Of course the decision will be appealed. That said, Branstad’s spokesperson Hammes’ statement praising the judge’s decision was interesting:

“More Iowans have access to quality mental health care and substance abuse treatment than ever before and as a result of mental health care redesign they are accessing locally and through modern means,” Hammes wrote in an email to the Register. “Gov. Branstad is committed to putting patients first, improving care, increasing access and modernizing the delivery of mental health services.  In fact, there are currently 726 psychiatric inpatients beds statewide, with 70 of them open. Iowa now maintains a robust level of access to mental health beds that are more efficiently delivered. The court’s ruling allows Iowa to continue implementing mental health care redesign to improve our mental health treatment for patients and that is the best news with today’s decision [1].”

The language here tends to support the view that there are plenty of psychiatric inpatient beds in Iowa, 726 with 70 open. However, I suspect the governor got those numbers from the controversial CareMatch mental health bed tracker system, recently under fire because hospitals are not updating it frequently enough. While the number quoted might have been accurate at the instant the governor was quoted–it didn’t stay that way.

If, as Governor Branstad claims, there is “robust access to mental health beds” then why do patients routinely wait in emergency rooms and critical care units for days on end waiting for psychiatric inpatient beds to open, even at the state’s academic medical center?

I’m on duty often enough to know the answer…there is not a “robust level of access” to psychiatric inpatient beds.

The mental health care redesign is described as “a remarkable accomplishment” in the face of a psychiatric physician shortage which is often not mentioned. Frankly, it’s tough to recruit physicians to rural areas. While telehealth (an interesting word itself) might be helpful, it’s not for everyone and has been poorly reimbursed. Iowa has 68 counties (out of a total of 99) in which there is no practicing psychiatrist.

And how exactly does the judge’s decision allow Iowa to continue implementing mental health care services improvement? No one has been standing in the governor’s way. In fact, there have been suggestions which he has ultimately rejected, notably the vision to build two new state facilities to replace the ones closed [2].

Once again, words are getting in the way, twisted to serve political agendas. According to the judge, Branstad sort of did the thing right but it’s debatable whether or not he did the right thing. Read that last sentence again, this time more slowly just to make sure you got it right.

Let’s all choose our words carefully. See you in New Orleans!


  1. Leys, T. (2015) Des Moines Register Branstad’s mental hospital veto was legal, judge rules. The Des Moines Register. Accessed online 11/9/2015.
  2. Leys, T. (2015) UI expert proposed building 2 new mental hospitals. The Des Moines Register. Accessed online 11/9/2015.