I’m off service for a while, which means I have more time for birds. Right now, my wife and I are trying not to spook the cardinals. It looks like they’ve finished the nest and we’re waiting for the eggs.
This will be the first time we’ve seen cardinals nesting in our yard. It’s a little strange, because the cardinals chose the same evergreen tree as the robins did last year.
The robins built a pretty sturdy nest but the cardinals just threw one together. It looks pretty flimsy.
A couple of years ago, chipping sparrows raised chicks in one of our front yard evergreen trees. They were cute.
But the baby robins looked like little dinosaurs.
I imagine the new cardinals will look pretty scruffy.
Long day on the C-L Psychiatry service. I logged 2.8 miles and 33 floors on my step counter. I barely had time to eat lunch. This post is going to be short.
We were treated to outstanding presentations on fascinating topics over the last couple of days and they were given by top-notch medical students. One of them summarized the literature on mental illness in the population of incarcerated women. The other was a great overview of catatonia.
The students put a lot of work into them. The data search was obviously thorough and their presentations were polished. They had very well organized PowerPoint slides.
They were among the best examples of Clinical Problems in Consultation Psychiatry (CPCP) learning sessions in recent memory. The CPCPs were a frequent feature in my previous blog, The Practical C-L Psychiatrist.
The CPCP was developed by a former teacher of mine, William R. Yates, MD. He was the head of the C-L Psychiatry service years ago before moving on to the University of Oklahoma in Tulsa.
He’s a part time research psychiatrist for the assessment team at the Laureate Institute for Brain Research. They do research diagnostic assessments for a variety of imaging, genetic and biomarkers studies in mood, anxiety and other brain disorders.
The CPCP format is:
A weekly case conference held Wednesdays from 8:00 a.m. to
approximately 8:45 a.m. Each week, a case is selected from the Daily Review
Rounds Records to illustrate a clinical problem for the next week’s
meeting. The residents are assigned dates when they rotate. The medical
students are welcome and even encouraged to participate as well.
This is a practical way to approach teaching the
Practice-Based Learning & Improvement Core Competency. This helps develop
the habit of reflecting on and analyzing one’s practice performance; locating
and applying scientific evidence to the care of patients; critically
appraising the medical literature; using the computer to support learning and
patient care; facilitating the education of other health care professionals.
This is applying principles of evidence-based medicine (EBM) to clinical
practice.
Evidence-based
medicine is a systematic approach to use up to date information in the
practice of medicine
Skills
are needed to integrate the available evidence with clinical experience
and patient concerns
Application
and evaluation of EBM skills will provide a frame-work for life-long
learning.
Self-evaluation is vital to the successful practice of EBM:
Am
I asking answerable clinical questions?
Am
I searching the literature?
Am
I becoming more efficient in my searches?
Am
I integrating my critical appraisals into my practice?
The assigned resident is responsible for searching the
literature and selecting one or two teaching papers for the conference.
Presentations will begin with a review of the case, followed by a summary of
the references with subsequent round table discussion.
Circulate copies of 2-4 pertinent articles to team members
including psychiatric nurses and faculty. A copy machine is available in the
departmental administration office. Consult staff can also assist with
obtaining copies.
Presentations begin with a 5-minute summary of the case with discussion of both psychiatric and medical aspects of evaluation and management. The remaining time is spent summarizing the pertinent data in the articles. Residents and medical students are encouraged to use the case conference material as preparation for submitting a case report or letter to the editor.
Bill and a former chief resident of psychiatry, Dr. Terri Gerdes, published a paper about the CPCP (then called problem-based learning in consultation psychiatry) in 1996:
Yates, W. R. and T. T. Gerdes (1996).
“Problem-based learning in consultation psychiatry.” Gen Hosp
Psychiatry 18(3): 139-144.
Abstract: 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.
The year that was published was the first year of my appointment to the Clinical Track faculty in the department of Psychiatry at The University of Iowa Hospitals and Clinics. I learned a lot from Bill.
And I’m confident that the students who presented their own CPCPs this week will teach many other trainees in their careers.
The cardinal nest is pretty much done—no eggs yet, though. At least we think it’s a cardinal nest. It looks typical according to experts; loosely woven of twigs, leaves, stucco, and ponderosa pine accents. They’re pretty fussy about us snooping around the backyard evergreen tree they chose to build a home in.
Any day now, we’re hoping to see a clutch of eggs, bluish
white with brown markings. Or maybe pale green with brown-lilac spots. Or
possibly whitish to pale bluish or greenish white, marked with brown, purple,
and gray. Or Hawkeye black and gold. It all depends on which guidebook you read,
I guess.
I’m gradually getting back into bird watching and spending
less time with my head at the hospital (“Earth to Jim!”). Doctors learn to
spend all their time either on the wards or in the clinic. It reminds me of a
couple of scenes from Men in Black (MIB) II.
As Agent J walks into the MIB complex at Battery Park, the
elevator dude says “Don’t you ever go home? Agent J says “Nope.”
Later he drops into Zed’s office and asks, “What you got for
me?”
Zed replies, “Look. See those guys in black suits? They work
here. We got it covered.”
That’s how physicians can get after years of acculturation
into the driven doctor model. Often enough, I take most of the work away from
the trainees, when they’re not looking. And I take my work home—that’s called
pajama time.
Hey, those dudes work here too. I have a tendency to see
myself as almost indispensable, which makes it hard to envision retirement at
times.
I have to keep reminding myself that I’m not the only doc who can do my job. The next generation of doctors are eager and ready. They deserve a chance. But I sometimes catch myself telling old war stories about how hard it was when I was a resident or a junior attending.
“I remember when I had to walk 40 miles to work in the driving
blizzard alternating with blazing heat (it’s Iowa) to get to my 6 x10 foot
office in the basement to stoke the fire in the pot-bellied stove for coffee
and grits at 4:00 in the morning, before the damn birds even get up, milk a few
dozen cows in the atrium, chase the pigs out of the operating rooms and then go
see about a hundred or so consultations before 7:00 in the morning I tell you, then
write notes until midnight, be on call until 3:30 the next morning and do it
all over again. What do you guys know about work?”
I may exaggerate a little bit. Usually there weren’t that
many cows in the atrium.
It can be difficult to unwind from the physician’s
treadmill. But as time goes on, I look forward to seeing the birds build nests,
to see the brand-new eggs, the ugly chicks who look like little dinosaurs until
the feathers grow out. I can pay more attention to the world outside the
hospital, where the new doctors are stoking the fire.
I’m a big fan of the Men in Black movies. I’m not going to
tell you how many times I’ve watched them on TV (78 million and if that number
reminds you of a scene from Men in Black, you’re just as much a fan as I am, if
not worse). One of my favorite lines is when Zed says to Edwards, “Edwards.
Let’s put it on.” Edwards asks, “Put what on?” And Zed says, “The last suit
you’ll ever wear.”
Today, I asked my secretary to order some new white coats for me. I went down to the Uniform Shop and checked on it. All they need is the requisition and they’ll get it.
Since I’m retiring after this year, these are the last white coats I’ll ever wear. There’s no Zed to tell me that. The Uniform Shop staff person won’t know it when the coats arrive—unless I tell her, of course.
I found a very long, involved discussion on the web about the meaning of Zed’s “last suit you’ll ever wear” statement. All I got out of it was that some people take that movie way too seriously.
But for me the last white coat I’ll ever wear means exactly that. I’m going to wear the coat until I retire (in about 14 months according to the countdown)—and then I’m never going to wear white coats again.
I can almost hear certain persons snickering in the background. I suspect there may be a few bets about this retirement thing being another temporary leave-taking, like the times I left for private practice and came back, sort of like bringing Agent K back after neuralyzing him at his request. He really did retire—temporarily.
But nobody is going to neuralyze me. I’ll keep a lot of
memories about my time as a Consultation-liaison (C-L) Psychiatrist, even
though some of them are sort of like Agent K’s memories of being swallowed by a
giant interstellar cockroach.
However, that reminds me of a few thoughts I have about institutional memory. I’ve mentioned my concerns about being practically the only C-L Psychiatrist in a pretty big hospital and retiring. I’m a geezer, but I know a lot about the ins and outs and moving parts and what it means to be a one-man hit-and-run fireman psychiatric consultant in a large academic medical center.
Institutional memory…
Institutional memory has been defined as “the collective
knowledge and learned experiences of a group. As turnover occurs among group
members, these concepts must be transitioned. Knowledge management tools aim to
capture and preserve these memories.”
Institutional memory can also be characterized briefly as:
Accumulated knowledge, skills, “this is the way we do things”
Some of it gets hardened into policies and procedures
Much of it “…resides in the heads, hands, and hearts of individual managers and functional experts.”- “How to Preserve Institutional Knowledge” by Ron Ashkenas, Harvard Business Review, 2013
Too much of anything for too long can be bad, including institutional memory
The bullet point that Ron Ashkenas makes above is relevant
to employers of baby boomers like me who know informal procedures, and have the
skills (and they chose us so they recognized the skills, so don’t be calling us
sport, feisty, hon, sweetie, or anything like that) and knowledge that’s in our
heads but may not be stored anywhere else.
That makes the baby boomer retirement phenomenon a real challenge. About 10,000 boomers will reach the age of 65 every day for the next 15 years. And most of us aren’t kidding around. There’s no way to just deneuralyze us to make us come back. You can’t make it happ’n Cap’n.
There are ways to package institutional memory into handy
things like mentoring partnerships, knowledge wikis, snappy videos (just shoot
the damn thing!) and other media that are easily accessible and geared for the
adult learner.
You can’t beat the Internet Archives for history. You can borrow and read the first edition of the Massachusetts General Hospital Handbook of general hospital psychiatry published in 1978, just like checking it out from a public library. Read the chapter, “Beginnings: liaison psychiatry in a general hospital.” You can learn from Dr. Thomas P. Hackett about the difference between a consultation service and a liaison service:
digital institutional memory
“A distinction must be made between a consultation service
and a consultation liaison service. A
consultation service is a rescue squad.
It responds to requests from other services for help with the diagnosis,
treatment, or disposition of perplexing patients. At worst, consultation work is nothing more
than a brief foray into the territory of another service, usually ending with a
note written in the chart outlining a plan of action. The actual intervention is left to the
consultee. Like a volunteer firefighter,
a consultant puts out the blaze and then returns home. Like a volunteer fire brigade, a consultation
service seldom has the time or manpower to set up fire prevention programs or
to educate the citizenry about fireproofing.
A consultation service is the most common type of psychiatric-medical
interface found in departments of psychiatry around the United States today.
A liaison service requires manpower, money, and
motivation. Sufficient personnel are
necessary to allow the psychiatric consultant time to perform services other
than simply interviewing troublesome patients in the area assigned. He must be able to attend rounds, discuss
patients individually with house officers, and hold teaching sessions for
nurses. Liaison work is further distinguished from consultation activity in
that patients are seen at the discretion of the psychiatric consultant as well
as the referring physician. Because the
consultant attends social service rounds with the house officers, he is able to
spot potential psychiatric problems.”—T. P. Hackett, MD.
By the way, have you seen my YouTube Channel? I’ve been beaming me up into educational videos for residents and medical students for a while now.
Next year I’ll be
doffing the white coat for good—but I’ll be on THIS planet.
Reference:
Hackett,
T. P., MD (1978). Beginnings: liaison psychiatry in a general hospital. Massachusetts
General Hospital: Handbook of general hospital psychiatry. T. P. Hackett, MD
and N. H. Cassem, MD. St. Louis, Missouri, The C.V. Mosby Company: 1-14.
About 15 years ago, I left my position at the University of Iowa to work somewhere else. The spiral notebook with a picture of someone crossing a bridge and the fine birdhouse in the picture above were going away gifts.
There were many touching messages in the little book. Friends wished me well and reminded me to “Keep up on all the birds in your new neighborhood.” I was a birdwatcher then and I’m reaching back for that now.
One of them said, “I hope you find your new position to be everything you want it to be.”
I did not. I returned and everything I left was somehow changed. But I was the same old Jim. And later I left again–and again returned. And now the third leave-taking is approaching–retirement. I will not return. Maybe then my spirit will not be nostalgic.
OK, it was a long day on the general hospital psychiatry consultation service. This post is going to be short. I put 3.4 miles and 29 floors on my step counter today and I’m feeling every one of them right now. It’s almost 10:30 at night and I’m trying to find a way to end the evening on a high note before I hit the sack .
I found it by listening again to the University of Iowa Shortcoat Podcast (via Radio Public) interview with a former internal medicine resident I had the pleasure of working with, Dr. Keenan Laraway. He’s doing a Nephrology fellowship at the University of Pennsylvania.
The title of the podcast is “Night Float: Finding Mentors, Being a Mentor.” Although I’ve never thought of myself as a mentor, apparently Keenan thought I was one for him.
Dr. Keenan Laraway on mentorship.
Listen to the whole podcast, but just to feed my ego, won’t you please fast forward to about 10 minutes, 50 seconds and hear what Keenan has to say about Dr. Jim Amos?
It made my day. He gave me the highest compliment he can give anybody, which is that I think like an internist. He says that I taught him a whole lot about what it means to be a doctor.
That, more than anything, is going to be the hardest thing to leave when I retire.
I think a sense of humor is a wonderful thing. I was the
class clown in my youth. I remember my English teacher, Miss Piggott, wrote in
my report card that I was “A little too exuberant.”
Actually, I was a great deal too exuberant. My sense of humor tends to fall into the broad category of what author Dave Barry would call “booger jokes.” By the way, I just finished his latest book, Lessons from Lucy: The Simple Joys of an Old, Happy Dog. I highly recommend it. He mixes a little wisdom in with the booger jokes.
Dave Barry can do more than booger jokes.
As a psychiatrist, I’ve learned to look for a sense of
humor, exuberant or not, in the patients I’ve met. I point it out to them when
I think I detect it. They usually like hearing that. Only a very few are
nonplussed.
One of my teachers was George Winokur, MD, who everyone knows was a giant in psychiatric research. Dr. Winokur was the department chair at University of Iowa Hospitals and Clinics from 1971 to 1990 and had a unique and memorable style. I thought he had a fair amount of exuberance. He had a rolling, sort of gravelly laugh, especially during rounds when he would sometimes make a point of reminding trainees like me that we had a lot to learn, “You all don’t know how to diagnose Somatization Disorder!” I made sure I learned how.
When Winokur was department chair, he created a set of
“commandments” regarding personal behavior and comportment that have stood the
test of time. I don’t know if anyone else has tried to ensure that Winokur’s 10
Commandments be remembered, maybe even cast in a pair of stone tablets. Read
them and follow them.
Winokur’s 10 Commandments
Thou shalt not sleep with any UI Psychiatry
Hospital patient unless it be thy spouse.
Thou shalt not accept recompense for patient
care in this center outside thy salary.
Thou shalt be on time for conferences and
meetings.
Thou shalt act toward the staff attending with
courtesy.
Thou shalt write progress notes even if no
progress has been made.
Thou shalt be prompt and on time with thy
letters, admissions and discharge notes.
Thou shalt not moonlight without permission
under threat of excommunication.
Data is thy God. No graven images will be
accepted in its place.
Thou shalt speak thy mind.
Thou
shalt comport thyself with modesty, not omniscience.
More evidence that a sense of humor is prevalent amongst psychiatrists is the work some residents put into making a video (in two parts) about managing violent patients. I realize that the recent news stories about health care professionals often being the victims of violence from patients might make some think this is nothing to joke about. They were not joking. The video makes a good case for a method to manage the violent patient. It just makes it with an exuberant sense of humor.
Violent behavior by patients in the general hospital is often
caused by delirium. The proxy for delirium in the form of violence could be
what is called the “Code Green” here at our hospital.
The Code Green team at our hospital consists of a group of
people specially trained to use non-violent measures to help patients who are
violent get under control in order to minimize the risk of injury to themselves
and others. These events are often intense encounters in patient’s rooms,
hallways, lobbies, and other places in the hospital where patients who are
confused and out of control can wander. First and foremost, we try to contain
the patient to maintain everyone’s safety, and then ascertain why the patient
is confused and at risk for imminent violence or already perpetrating acts of
violent behavior toward themselves and others. This has to be done quickly so
as to minimize injury.
One mnemonic, described in my chapter in our book, Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry is [1]:
1. Amos, J.J., M.D., Assessment and management of the violent patient, in Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry, J.J. Amos, M.D., and R.G. Robinson, M.D., Editors. 2010, Cambridge University Press: New York. p. 58-63.
Containment before
Assessment before
Non-violent
Intervention before
Take down
Shameless plug…
The so-called CAN IT mnemonic is a reference mainly to
containment before all else in order to protect everyone involved in a Code
Green situation. An excerpt from the chapter on the importance of containment
is:
“Containment refers to ensuring that you and the patient both feel relatively safe in the assessment area. Preferably, both of you should have easy access to the door for escape if necessary. At first, it may seem odd to recommend letting the patient escape from the room, but the point is not to force the patient to run over you to get to the door.
Another issue of containment is to ensure that the patient gives up any weapons before you agree to do the evaluation. Sometimes, offering food or drink (not hot enough to injure if hurled in your face) will help set a non-threatening atmosphere. It’s helpful to avoid making intense or prolonged eye contact with the patient, because this may be viewed as threatening.
Always make sure that plenty of other people are available to help you if a take-down situation develops.
Containment under these conditions sometimes is achievable by simply being honest with the patient who is still able to hear you by admitting that he/she is saying or doing things that make you afraid. This may seem counter-intuitive. But, provided it’s delivered calmly as a statement followed by reassurance that you and everyone else involved are committed to maintaining the safety of all persons present (including the patient), this may capitalize on the patient’s own fear of losing control by assuring that you’ll do everything in your power to keep the lid on the situation.”
You can see the exuberant YouTube videos below, illustrating
these principles made by talented trainees in our psychiatry residency program
in 2008.
In 2009, Dr. David Mair, MD was the producer and director of the video. I see he’s now with Innovative Psychological Consultants (IPC) in Maple Grove, MN (they get a lot of snow up there!). Below is his introduction to the videos:
Early in my training, I didn’t quite know how to react with potentially
violent patients. No amount of knowledge
of medicine, physiology, or the DSM provided me the skills to address these
situations. Though we had excellent
training during orientation, I really learned by observing skilled clinicians,
and through my own encounters, both good and bad. This was exemplified during my rotation in
consultation-liaison psychiatry, when working with Dr. Amos, to learn his
logical, step-wise approach, see him in these problematic scenarios, and to
practice what I had learned.
In making this educational video, I wanted to give incoming residents a
quick way to make these observations, and present it to them in a way that was
both useful and entertaining. It helped that I had a cadre of multi-talented
peers and a faculty supervisor who recognized the utility of such a
project. Though managing these patients will
be an eternal source of anxiety for all psychiatrists, my hope is that with
this video, they will feel just a little better prepared. —David Mair, MD.
I’m noticing something about my readiness for retirement.
Certain activities are starting to be at least as interesting as my work as a
consultation-liaison psychiatrist at the hospital—maybe even more so.
For example, my wife and I are hoping that the cardinals
will come back to our backyard evergreen tree. They were building a Hoorah’s
Nest in there a week ago, which I took a picture of and then they left when they
saw us spying on them. This evening, my wife noticed they were back. We rushed
to the window (me with camera in hand) and I swear, they peered at us with
intense suspicion. Pretty soon, they flew off in a huff.
They are among the most stand-offish backyard birds I’ve
ever seen.
Why is this so important? It’s because I am getting so
absorbed in birdwatching again now that I’m in phased retirement that I find it
fascinating enough to look forward to more than going to work. I think that’s a
sign I’m finally beginning to adjust to retirement.
I spent 4 years in medical school, 4 years in residency, and
have worked for more than 23 years as a psychiatrist, mostly as a general
hospital consultant. Nothing used to jazz me as much as running around the
hospital, seeing patients in nearly all specialties, evaluating and helping
treat many fascinating neuropsychiatric syndromes, teaching medical students
and residents, and I even wrote a book.
On the other hand, I don’t want to hang on too long. When
people ask me why I’m retiring so early (“You’re so young!”), I just tell them
most physicians retire at my age, around 65. I also say that I want to leave at
the top of my game—and not nudged out because I’m faltering.
I saw a blog post that identified that reason for retirement. It was entitled “When Physicians Reach Their Use-By Date,” by James Allen, MD. The site is identified as “Not secure” unfortunately, so I’m not giving a link to it. However, the web site is The Hospital Medical Director and it’s sponsored by Ohio State University–so it’s probably safe.
Now if you do read Dr. Allen’s post, you’ll think I’m
flattering myself as a “master clinician.” I don’t think of myself that way. I’m
actually more of a demigod.
I’m just kidding. The descriptions of how physicians finally reach retirement sound fascinating. I’m not sure I could just abruptly stop—that’s why I chose phased retirement. Staying on as a preceptor is not appealing to me because I liked the clinical action too much. I’m actually afraid of becoming someone who knows only medicine. It’s one of the best reasons for me to retire sooner rather than later. You’d think I’d identify with the consultant model; I’ve briefly thought of carrying my resignation letter around with me, although not in my coat pocket and not with malice in my heart.
Although I joined the fraternity of medicine, so to speak, I’m
really not a joiner. In fact, I’ve gradually given up membership in organizations
like the Academy of Consultation-Liaison Psychiatry, the American Psychiatric
Association, and the American Medical Association. I’ve let go of social media
accounts like Doximity and LinkedIn—all of them actually, including Twitter and
Facebook; I just couldn’t get the hang of those.
There’s a National Association of Retired Physicians (NAORP)
that I’ve peeked at. There’s the University of Iowa Retiree Association (UIRA)
that I learned about a couple of years ago when my wife and I attended a
seminar about retiring from the university. I probably won’t join either one.
I’ve been getting invitations from AARP for many years now (who doesn’t?). The tote bags look nice and I am glad that somebody is lobbying for people my age. I haven’t joined so far.
And I joke about my own fictional organization, Retiree On My Own Time (ROMOT). No dues, no meetings, no minutes, no Robert’s Rules of Order. I’m the President, Secretary, Treasurer (Har!), and the only member—for now.
I know I’d been saying that I probably wouldn’t have time to
attend Wes Ely’s Grand Rounds presentation yesterday, “A New Frontier in
Critical Care: Saving the Injured Brain.” But against all odds, I
actually got to go, along with some medical students and a Family Medicine resident.
As I expected, Dr. Ely brought the house down. His talk was similar to the one he gave at Emory University in Atlanta, Georgia, but not identical. He described the results of the study “Haloperidol and Ziprasidone for treatment of Delirium in Critical Illness,” published last October in the New England Journal of Medicine. There’s a YouTube video of that in my March 28, 2019 post announcing his visit to Iowa City.
He also discussed in detail the ABCDEF bundle for protecting the brains of patients in the ICU.
When he outlined the history of intravenous haloperidol for the treatment of delirium in critical care units, I had to cringe because I remembered the continuous IV haloperidol infusion protocol (running at 5-10 mg an hour) developed by Riker and colleagues. I mention it for historical reasons only. I don’t recommend using it.
IV haloperidol for ICU Delirium
Riker, R. R., G. L. Fraser and P. M. Cox (1994). “Continuous infusion of haloperidol controls agitation in critically ill patients.” Critical care medicine 22(3): 433-440.
After his presentation, Dr. Ely asked for questions. I asked him what he thought the role of the psychiatrist is regarding ICU delirium. He actually recognized me; we met very briefly at a meeting of the American Delirium Society in Indianapolis several years ago.
Even better, he knew enough to mention the catatonic variant of delirium and the irony of using a benzodiazepine to treat it, which you would avoid like the plague in delirium (except for alcohol withdrawal, for example). However, benzodiazepines can reverse catatonia. See my post from April 10, 2019 (“Delirium and Catatonia: Medical Emergencies”). He thought psychiatrists would know more about that and would be important collaborators in managing catatonia.
Wes bringing the house down.
It’s difficult not to be excited by the advances in medicine
and psychiatry when an inspirational scientist, humanist, and visionary leader
like Wes comes to town. It makes me wonder how I’m going to get a buzz like
that out of anything I do in retirement.
On the other hand, I get a kick out of making silly videos.
Wes Ely, MD will be giving the Internal Medicine Grand Rounds today at noon at University of Iowa Hospitals and Clinics. The title of his presentation is “A New Frontier in Critical Care: Saving the Injured Brain.”
I’m on duty today in the general hospital as a psychiatric consultant. I’m pretty sure I won’t be able to attend Dr. Ely’s talk, ironically because I’ll be helping colleagues care for delirious patients.
But I found a YouTube video of the talk he gave with the same title. He delivered it in 2017 at a Critical Care Summit meeting at Emory University in Atlanta, Georgia.
I gave a talk to the medical students yesterday about delirium and dementia, which you can view in yesterday’s post. I urged them to try to attend Dr. Ely’s talk today because it would be a stellar, eye-opening, inspirational presentation. I talked about many of the same topics relevant to delirium that he does–but he’s a rock star. He’s a scientist and a humanist. I met him briefly at a meeting of the American Delirium Society several years ago and he’s brilliant.
I was listening to his talk via this YouTube video as I quickly tapped out this post. He’s an intensivist and focuses on delirium in critical care. While the focus of his talk is called “ICU delirium,” I think it’s important to realize that delirium is delirium–anywhere in the hospital or in nursing homes, skilled care facilities, and hospital emergency rooms.
The first-person video that Dr. Ely shows of a patient who developed what is essentially a dementia from prolonged delirium in the ICU is compelling. It’s a stunning revelation from someone who has not recovered from the neurocognitive injury that we call delirium. Some patients have even committed suicide because of the long-term brain injury resulting from delirium.
Dr. Ely makes the point that changing the culture of hospital medicine regarding the approach to assessing and managing delirium is a baby step process. It takes time.
Change happens, especially if we approach it as a team.
Go Retire Psychiatrist 