Halloween is upon us and if I don’t get this post out now, it won’t get done. As usual, it has been pretty busy on the Consultation-Liaison (C-L) Psychiatry service. I don’t think it has anything to do with the Halloween season–but it is a bit scary.
It’s also time for the annual C-L Psychiatry lectures to the junior residents, entitled ” Consultation-Liaison Psychiatry: Nuts and Bolts.” An excerpt of a few of the slides are below. Recall that one recent Clinical Problems in Consultation Psychiatry (CPCP) presentation was about improving the consultation questions from consultees. It’s astonishing (maybe even scary) how little has been written about this, Most of the articles and books addressing this perennial issue are decades old.
The most telling book section comes from the book “Sigmundoscopy: Medical-Psychiatric Consultation Liaison: The Bases” by David J.Robinson, MD, published by, interestingly, Rapid Psychler Press in 1999. The section is “Conducting the Consult,” starting on page 78 in which he reveals that many physicians often make vague consultation requests. He quips that these “consults” are often seen as “insults.” The book has been recommended by none other than Don R. Lipsitt, MD, who has himself authored a definitive history of C-L Psychiatry, “Foundations of Consult-Liaison Psychiatry: The Bumpy Road to Specialization.”
He also mentions another book in which one of our former residents, Dr. Jeanne Lackamp, MD, Director of the Division of Psychiatry and Medicine at University Hospitals Cleveland Medical Center, as well as an Assistant Professor of Psychiatry at Case Western Reserve University School of Medicine (I hope that’s current although it wouldn’t surprise me if she’s been promoted), wrote the opening and outstanding chapter on the consultation process. About 44 minutes into the fascinating podcast at the link above, she talks about her experience of having a calling to C-L Psychiatry.
Dr. Lackamp has also written a very engaging and humorous paper outlining the stages of consultation-liaison psychiatry (Lackamp, J. M. (2015). “The stages of consultation-liaison psychiatry.” Acad Psychiatry 39(2): 217-219). It should probably be required reading in the C-L Psychiatry section of any psychiatry residency program. Her introductory remarks about the topic give you an idea of her talent and depth of experience:
The process of learning, no matter how rewarding, can be daunting. It is important to recognize various stages, in order to identify stress (and its manifestations) on Psychiatry residents—and the patients and teams with whom they work. Humor can help residents cope and can bring levity to an admittedly exhausting training experience.
The following tongue-in-cheek essay was informed by countless consultations and hours of resident supervision. It is written in the spirit of the New Yorker’s “Shouts and Murmurs” column, with inspiration from Elisabeth Kübler-Ross’s “Stages of Grief.”
She’s one of the best representatives for General Psychiatry, let alone C-L Psychiatry. Furthermore, we have several talented residents in our current class who will doubtless be leaders in any field of psychiatry they choose. Several are interested in pursuing careers in C-L Psychiatry.
When I mention careers in psychiatry, it reminds me of where I am in my own trajectory, which is phased retirement. But even now at my age, I’m still walking the C-L Psychiatry mascot, Winston currently, down to the gift shop all the way across the hospital in front of everybody (it gets a lot of smiles) to get a shot of gas because mascots get as tired as C-L Psychiatrists do. There is a sort of analogy. Over the short as well as the long term, psychiatrists can change–over a busy day or over a busy career.
Walking the mascot is a useful way to remind me of the importance of humility in the practice of psychiatry. The other way to remember humility is to sit down whenever possible when listening to patients in the general hospital. I still use the camp stool and I’ve yet to hear any patients or their family members disapprove of me unwrapping my little chair, sitting down, and hearing them. Some of them still mistake my camp stool for nunchucks, though.
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