I’m ambivalent about it because of what would have to be done. It would be a lot of work (putting it mildly) to get this through the American Board of Medical Specialties. I’ve mentioned this in a previous post. Again, the American Psychiatric Association might decry the proposal as further balkanization of psychiatry. On the other hand, Dr. Larry Faulkner, MD, President and CEO of the American Board of Psychiatry and Neurology, might welcome the change. Think of the cash flowing in from diplomates for Maintenance of Certification (MOC) “products” including recertification exams!
I’ve not yet heard from one of my colleagues in Neurology whose opinion I asked for about Bill’s proposal. I get the sense many residents in both Neurology and Psychiatry probably would rather than fight than switch at this point in their careers.
Dr. Don Lipsitt, author of “Foundations of Consultation-Liaison Psychiatry: The Bumpy Road to Specialization,” which I’ve just begun reading, said the term “Neuroscience Medicine” didn’t “do it” for him as a replacement for “Psychosomatic Medicine.” My little poll shows that “Consultation-Liaison Psychiatry” was the most popular name. You can still vote if you like.
I noticed that the word “psychosomaticist” turns up in Don’s book, which surprised me a little. I thought I made that up just for my blog. He mentions it in the first section “Seeds and Roots.” As Bill points out, the word psychosomatic may be a holdover from the days of Freud and psychoanalysis–but the roots are long and strong and it might be going too far to say that “psychoanalysis is dead.” However, in the era of what might be called biological reductionism, this stance might attract more than a few medical students to Neuroscience Medicine.
It’s fair to point out that even in Bill’s proposal, psychology has a place as a supporting specialty. How could it not? And it’s not a novel proposal. In fact, as I’ve already mentioned in a previous post, there is a combined Neurology and Psychiatry training program at the NYU Langone Medical Center. I sent the Program Director, Siddhartha Nadkarni, MD, an email message asking for an opinion about the issue.
Doing what I do every day as a psychiatric consultant in the general hospital is analogous to what a smokejumper (fireman) does. I put out fires. I don’t need hardly any neuroscience training for that. In fact, most of the time all I need is a chair–to sit down and listen to patients and families.
Of course, I’m aware that empathy, while essential, is not sufficient to make a difference in the world of medicine. My colleague, Dr. George Dawson, says psychiatry should be more like opthalmology. I wish we could make it so.
It makes me wonder. If a Neuroscience Medicine specialty is approved, what will happen to all of the general psychiatrists and neurologists…and the psychosomaticists? And if the new discipline is to “reduce the burden of brain disorder around the world,” how will it do that?
Bill is making a great effort to move medicine forward. Don is also making a great effort to give us perspective on where medicine has been.
We need both. Otherwise we risk sitting around dreaming about the past.