Go Retire Psychiatrist

I ran across an old blog post I wrote in 2011 on preventing delirium and thought it would be interesting to share it. In all fairness, I think attitudes have changed for the better in the last several years.

Blog: Do you have to be interested in Psychiatry to Volunteer for the Delirium Prevention Project?

“I’ve been thinking about what a couple of the medical students said when I broached the idea of some of them volunteering to participate in the multicomponent intervention of the delirium prevention project.

They said that the first and second year students might want to volunteer—especially the ones interested in pursuing psychiatry as a career.

Now think about that a minute. Why would you necessarily need to be interested in psychiatry? Here are a few facts:

1. Delirium is a medical emergency; it just happens to mimic psychiatric illness because it’s a manifestation of acute brain injury.
2. The most important treatment for delirium is not psychiatric in nature necessarily; the goal is to find and fix the medical problems causing the delirium.
3. Many experts in delirium are not psychiatrists; the authors of the new book “Delirium in Critical Care”, Valerie Page and Wes Ely, are not psychiatrists—they’re intensivists.
4. Some of the best teachers about delirium are geriatric nurse specialists and geriatricians.

I thought that by reaching back further into a physician’s training career, I would find people less biased toward thinking of delirium as a primary mental illness. It turns out that bias runs deep in our medical education system.

It isn’t that psychiatrists shouldn’t be interested in studying and helping to manage delirium. Psychiatrists, especially those specializing in Psychosomatic Medicine, are among the best qualified to inform other medical and surgical disciplines about the importance of recognizing delirium for what it is—a medical problem that threatens the brain’s integrity and resilience, raises the risk of mortality by itself regardless of the medical problems causing it, prolongs medical hospitalization, and makes discharge to long term care facilities more likely, especially in the elderly.

Delirium is a problem for doctors, not just psychiatrists. So it makes sense for all medical students, regardless of their goals for career specialty, to be interested in learning about delirium.

Delirium is also a problem for nurses, who frankly have led the way in education about delirium for many years now. You’ll find few experts pointing to the American Psychiatric Association practice guidelines for the treatment of delirium as the ultimate authority these days—because they’ve not been updated formally since 1999. All one has to do is spell out “delirium prevention guidelines” in web browser search bars and choose from several sets of free, up-to-date guidelines that are supported by the research evidence base in the medical literature to within a year or two of the present day. Some of the best ones are authored by nurses.

So maybe the pool of volunteers for the delirium prevention multicomponent intervention might be nursing students.

On the other hand, from what pool does the Hospital Elder Life Program (HELP) recruit volunteers? And the Australian Resource Center for Healthcare Innovation multicomponent program, ReVive (Recruitment of Volunteers to Improve Vitality in the Elderly, how do they do it?

They think outside the box and include people who care about people. That’s really the key criterion, not whether one wants to be a psychiatrist or not.”