CPCP: Drug Induced QT Prolongation by Top-Flight Medical Student

We got an outstanding Clinical Problems in Consultation Psychiatry (CPCP) today, on drug-induced QT prolongation by medical student Lisa Wehr. Lisa is interested in pursuing a combined residency in internal medicine and psychiatry. Hmmm…Iowa has one of those.

This got kicked off when I noticed a Letter to the Editor of Psychosomatics, co-authored by Dr. Jeanne Lackamp, MD, who graduated from our residency program and is now head of the psychiatry consultation service at University Hospitals Cleveland Medical Center/Case Western Reserve University Cleveland, Ohio. The letter was titled “Routine Corrected QT Interval Monitoring With Antipsychotic Use in the Consultation-Liaison Setting: Playing the Devil’s Advocate.” The reference is listed in Lisa’s presentation.

This challenged my thinking about the QTc interval, which I take for granted as is from the “machine” reported EKG. As Lisa points out, it’s more accurate to measure the QT interval manually because it can be influenced by so many factors including but not limited to heart rate.

Lisa’s approach is scientific. And it didn’t surprised me to discover she participated in a recent Shortcoat Podcast “314 Action: Encouraging People of Science to Make the Leap Into Politics.” Consider checking it out because it could stretch your thinking a bit.

Politics is often a polarizing business, to state the obvious. I might add that, in the same issue of Psychosomatics, there was an article on the process of negotiation, which mentioned one of a couple of books I used to recommend to medical students (Siegel, A. M. and H. R. Bleier (2017). “The Role of Negotiation in Consultation-Liaison Psychiatry.” Psychosomatics 58(2): 187-190). Getting to Yes by Fisher, Ury, and Patton has some pointers about getting past the adversarial blockages using four major tenets: Separate the People from the Problem; Do not Argue on the Basis of a Position or Set of Positions. Identify the Core Interests of All Parties; Use Objective Criteria; Invent Options for Mutual Gain.

Maybe some politicians would find this approach useful. C-L psychiatrists certainly do.
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