So, Day 4 of the Academy of Psychosomatic Medicine (APM) Meeting and I thought I would start by saying that another attendee at one f this morning’s Oral Paper Sections, while scrolling through the APM App on her smartphone, actually asked me how to find which session she was currently attending! She couldn’t tell! I showed her on my paper schedule (just sayin’).
Anyway, I thought the Plenary Session was very thought-provoking, “President’s Symposium Part 2: An Educational and Research Approach to Patient-Centered Communication” featuring speaker Grayson Norquist, MD, MSPH and Dennis Novack, MD.
Dr. Norquist’s lecture, “Improving Clinical Communications through a Patient-Centered Approach” included his remarks which echoed almost exactly my own regarding the imposition of Relative Value Units (RVUs) as a measure of clinical productivity–it basically sucks.
OK, he didn’t use the word “sucks.” But he could have. In fact, he observed the oft-noted decline in fee-for-service “widget” work (in fact he did use the word “widget”) in favor of population-based integrated care models, highlighting the ironic move some academic medical centers (including psychiatry departments) are making to establish RVU components in their compensation plans. Some are going so far as to email the quarterly RVU count to psychiatrists–along with an apology that the number doesn’t come close to evaluating productivity for consulting psychiatrists because of the complexity of our work–which is vital whether or not we make money.
No, I’m not going to show you my RVU statement this quarter–or any other quarter, for that matter.
The second speaker, Dr. Novack, highlighted the ongoing resistance to specific objectification of professionalism in his talk, “Psychosomatic Medicine, Communication and Professional Formation: Educational Imperatives for Medical Education.” My interpretation of one of the possible take-home messages is that professionalism is teachable, but is best thought of as an inside-out, reflection-generated development of certain virtues, (courage, humility, etc.) that are fruitfully and hopefully, role-modeled for trainees.
I attended the Neuropsychiatry Section later in the morning. I was flattered and flabbergasted that one of my role models, Dr. Jose Maldonado, MD, President-Elect of the American Delirium Society (ADS) actually crossed the room to shake my hand! At first, I though he mistook me for someone else but I gather he’s read my blog (so it might be good for something). I think he believes that a geezer like me actually might have some sort of a role to play in ADS.
I hate to disappoint him; I thought everyone knew that I’m just the rodeo clown of Psychosomatic Medicine.
Anyhow, Dr. Maldonado described his work on the new Stanford Proxy Test for Delirium (S-PTD), a screening tool that he modestly says was developed by nurses for use by nurses. On the other hand, his story about how he developed the 12 question observational tool containing complicated questions that nurses would never find useful or even intelligible might just make sense. The Confusion Assessment Method (CAM) was the instrument I envisioned using several years ago in our hospital’s Delirium Early Recognition and Prevention process improvement program. In fact, nurses eventually won out, preferring the Delirium Observation Screening Scale (DOSS).
It was obvious that Dr. Stephen Pesanti’s presentation “A Retrospective Analysis of Underlying Ethical Issues Driving Psychiatric Capacity Evaluation Requests” was enormously well-received because what psychiatric consultant has not received an “unwarranted” (his generous name for it) decisional capacity assessment (DCA) request? In fact, his study showed that anywhere from 5-30% of these requests may be unwarranted, hiding some other issue which psychiatrists may or may not be helpful for. Dr. Pesanti gave some hilarious examples of some of the more interesting questions, clearly showing that the primary team had already done excellent DCAs themselves, yet still expected something more from psychiatric consultants. What’s going on? In some cases there are other problematic psychosocial or disposition-planning issues prompting the consultation request. In others, there might be policies governing the need for second opinions (in some jurisdictions, specifically from psychiatrists) from the hospital. Further, there might also be defensive medicine motivations involved.
The Awards luncheon was special this year, marking the passing of two of APM’s, (indeed Psychiatry’s), most respected, even loved leaders: Dr. Wayne Katon and Dr. Ned Cassem. We knew that, even without the speakers’ pauses in order to conceal the catch in their voices.
Well, I’d better be getting along because I don’t want to miss Dr. Vicki Kijewski’s part in the next session I want to attend: “Medical Psychiatric Inpatient Integrated Care Models: History, Challenges and Benefits Shared by Four Institutions.