I’ve been a Consult-Liaison Psychiatrist at The University of Iowa Hospitals & Clinics (UIHC) for 20-odd years except for very short stints in private practice which didn’t suit me because I missed teaching. I’m in phased retirement now and plan to be fully retired in a couple of years.
I used to say that I’m “board certified by the American Board of Psychiatry and Neurology (ABPN) in both Psychiatry and Psychosomatic Medicine.” There are a couple of reasons I can’t say that now. Things have changed.
Firstly, now I have to say that I’m “certified,” and “not meeting MOC requirements.” Maintenance of Certification (MOC) is the lifelong learning system the American Board of Medical Specialties (ABMS) and the member specialty boards came up with years ago. I chose not to pay the fee in December 2017 to the ABPN to sit for what would have been my last recertification exam.
MOC has been a source of controversy for physicians all across America. Many physicians including me don’t believe there is compelling evidence that it improves patient care or physician competence. I used to spend a lot of time and effort protesting against MOC. And my latest protest was just to stop paying for something I don’t believe in. The prospect of retirement has led me to soften my peppery firecracker position on the issue. I haven’t changed the ABMS or the ABPN.
“Yesterday I was clever, so I wanted to change the world. Today I am wise, so I am changing myself.”–Rumi.
However, I believe in the principle of lifelong learning and I still encourage trainees to participate in the Clinical Problems in Consultation Psychiatry (CPCP). It’s one way to meet the core competency of Practice-based Learning and Improvement. My former teacher, Dr. William R. Yates, MD, and a former Chief Resident, Dr. Terri Gerdes, wrote a paper about it, when it was called problem-based learning:
“Yates, W. R. and T. T. Gerdes (1996). “Problem-based learning in consultation psychiatry.” Gen Hosp Psychiatry 18(3): 139-144.Yates, W. R. and T. T. Gerdes (1996). “Problem-based learning in consultation psychiatry.” Gen Hosp Psychiatry 18(3): 139-144. Problem-based learning (PBL) is a method of instruction gaining increased attention and implementation in medical education. In PBL there is increased emphasis on the development of problem-solving skills, small group dynamics, and self-directed methods of education. A weekly PBL conference was started by a university consultation psychiatry team. One active consultation service problem was identified each week for study. Multiple computerized and library resources provided access to additional information for problem solving. After 1 year of the PBL conference, an evaluation was performed to determine the effectiveness of this approach. We reviewed the content of problems identified, and conducted a survey of conference participants. The most common types of problem categories identified for the conference were pharmacology of psychiatric and medical drugs (28%), mental status effects of medical illnesses (28%), consultation psychiatry process issues (20%), and diagnostic issues (13%). Computerized literature searches provided significant assistance for some problems and less for other problems. The PBL conference was ranked the highest of all the psychiatry resident educational formats. PBL appears to be a successful method for assisting in patient management and in resident and medical student psychiatry education.”
Secondly, the name “Psychosomatic Medicine” for my specialty will officially change to Consultation-Liaison Psychiatry (C-L Psychiatry) as of mid-April 2018. Few of us cared for the other name. I like to think that I and many other colleagues did influence the ABMS and the ABPN about the name change.
When I was Chief Resident back in the day, I remember talking to an incoming class of residents about Stephen Covey’s book “The 7 Habits of Highly Effective People” and his principles centered leadership philosophy. I still believe that leadership is a choice, not a position. Unfortunately, some of our physician leaders may go astray. But change is constant. Leaders come and go. And just like the song says, “I’m so glad trouble don’t last always.”
One of my most treasured achievements is the Leonard Tow Humanism in Medicine Award. The Arnold P. Gold Foundation has recently announced they are rebranding the organization and the pin will have a different look. The new pin includes a Mobius loop “…as a symbol of the continuous bond of trust, respect, and communication that connects healthcare professionals with their patients when humanism is at the core of practice.”
I think one of the most helpful things I can do to foster communication with my patients in my role as a C-L Psychiatrist in the general hospital is to sit down and listen to them. Often there are not enough chairs in a hospital room. I used to ask trainees to find one for me. For the last couple of years, I have my own portable camp stool I take with me on rounds. It was a gift from a friend and colleague. Patients get the biggest kick out of it.
When I retire I’ll stop using that camp stool, . It would be a shame to just take it home and stick it in a drawer. Maybe I should pass it on when I go.
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