University of Iowa Psychiatry Residents Get Shout Outs

Recently, University of Iowa psychiatry residents worked hard enough to get shout outs. One of them was exemplary performance on the consultation and emergency room service. The service was following over two dozen inpatients and received 15 consultation requests in a day. This is a staggering number and the resident on the service did the job without complaints. In addition, the resident was the only trainee on the service at the time. Other residents were working very hard as well.

This high level of performance is outstanding and raises questions about health care system level approaches to supporting it.

I read the abstract of a recently published study about Mindfulness Based Stress Reduction (MBSR) compared to medication in treating anxiety in adults (Hoge EA, Bui E, Mete M, Dutton MA, Baker AW, Simon NM. Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders: A Randomized Clinical Trial. JAMA Psychiatry. Published online November 09, 2022. doi:10.1001/jamapsychiatry.2022.3679).

On the day I read the abstract, I saw comments which were cringeworthy. The commenter is an outpatient psychiatrist in private practice who had some criticisms of the study. He thought the report of results at 8 weeks was inadequate because symptoms can recur soon after resolution.

Another problem he mentioned is worth quoting, “A course of treatment that requires as much time as the MBSR course described in the study would be out of the question for most of my patients, most of whom are overworked health care professionals who don’t have enough time to eat or sleep. Telling people who are that overworked they should spend 45 minutes a day meditating is the “Let them eat cake” of psychotherapy.”

That reminded me of a quote:

“You should sit in meditation for twenty minutes every day—unless you’re too busy; then you should sit for an hour.”

Zen Proverb

I know, I know; I should talk—I’m retired. Actually, I took part in an MBSR course about 8 years ago when I noticed that burnout was probably influencing my job performance on the psychiatry consultation service. I thought it was helpful and I still practice it. I was lucky enough to participate in the course after work hours. The hospital supported the course.

The residents who are being recognized for their hard work on extremely busy clinical services may or may not be at high risk for burnout. They are no doubt extra resilient and dedicated.

And the University of Iowa health care system may also be offering a high level of system support for them. I don’t see that University of Iowa Health Care is on the list of the American Medical Association (AMA) Joy in MedicineTM Health System Recognition System, but that doesn’t mean they aren’t doing the kinds of things which would merit formal recognition.

Anyway, they all get my shout out.

Evolutionary Thoughts

By now, you’ve probably read the digital news article describing how we’re all going to evolve into beings who resemble extraterrestrials (ETs) because of our preoccupation with digital technology.

The authors describe us as eventually developing another eyelid that’ll protect us from the blue light emanating from our gadgets. Our hands will become claw-like and permanently flexed because of the way we’re always gripping our smartphones.

You’ll also develop a third hand that protrudes from your butt so you can catch your cell phone as it slips out of the back pocket of your skinny jeans. Come to think of it, that’ll also give rise to a weird new meaning for the term “butt dialing.”

Of course, the article is a criticism of our preoccupation with our gadgets, but it’s still fascinating as speculation about how creatures, including humans, evolve in response to the pressures in our environment.

This kind of thing makes me wonder whatever happened to Neanderthal. The males were huge, especially their arms, which came from frequent arm wrestling with Sasquatch for the last shred of beef jerky. Neanderthal had a very prominent brow which developed to keep snow and pterodactyl droppings out of his eyes.

And this reminds me of the discovery of the fossil of a giant creature on the Greek island of Crete in 2003 (I think). The skull had a huge nasal opening in the center of the skull. That was probably for a trunk, as in elephant trunk. But paleontologists thought it might have been the explanation for why ancient Greeks came up with stories about the terrifying one-eyed cyclops.

And what about that carp with a human-like face on the top of its head? I saw that one a week ago on the show The Proof is Out There. I thought sure Michael Primeau, the forensic video analyst on the show, would dryly dismiss it (“This video is clearly faked.”). Instead, the other experts thought it was natural. Tony summarized it as an example of the “plastic” evolution, by which I think he meant phenotypic or evolutionary plasticity. These are changes in a creature’s appearance, morphology, or physiology in response to changes in its environment. Regarding the carp, one expert opined that the face would confuse its main predator, the eel, by confusing it.

I still don’t get that one. How would the carp species even begin the evolutionary process? Does the carp just think, “Huh, I think that eel might get confused if I had a face like a human”? I get it that the changes occur at the genetic level, but how exactly does it get started?

Could you google the answer? I couldn’t find anything specific, like x plus y equals human-like face on a fish that many humans would not care to eat.

And how about writing? I wrote this blog post longhand using pen and paper, something I gave up doing years ago but which I am sort of rediscovering gradually. I had an old typewriter for a while, which gave way to something called a word processor, which was a stand-alone device made writing and editing text, and eventually I got a computer—which really messed things up.

The thing is, I can remember getting something called writer’s cramp. If you remember that, then you probably recall how painful it was. Back then, did anyone ever wonder whether that would lead to the evolution of a claw like hand?

Could evolution have consequences pertinent to people who are always looking up at the sky looking for UFOs? Some of them, for some unexplained reason, never seem to have a smartphone with them. Anyway, could their eyes migrate, carp-like, to the top of their foreheads to counter neck strain? And could this lead to the evolution of a third eye in the center of the forehead? It would prevent falling into manholes. There are other consequences from evolving into a cyclops.

We would be adept at forging thunderbolts. We would be very talented at cultivating vineyards and herding sheep and goats. But our tempers would still be pretty bad, even worse. We would abandon courts of law and ignore justice. We would be violent giants, feasting on the flesh of ordinary humans. All this because we kept searching the sky, hoping to see UFOs and see ETs, which we would eventually resemble anyway because of our preoccupation with our devices.

I have a pretty good supply of pens and paper.

Heard it on the Big Mo Blues Show

I heard John Heim aka Big Mo on the blues show tonight on KCCK radio 88.3 and he actually spelled the name of MayRee, the name of the cook who makes that good hand-battered catfish; it’s better because it’s battered and so the legend goes.

I knew a cook a long time ago in Austin, Texas, her name was Miss Mack. She ran the student cafeteria at Huston-Tillotson College (now Huston-Tillotson University) in Austin, Texas way back in the 1970s. It’s one of the country’s Historically Black Colleges and Universities (HBCUs). And it’s one of the oldest.

Some students made fun of Miss Mack’s food. Some were brave enough to eat it. I was one of them, but I did make a Church’s Chicken run occasionally. Church’s Chicken was a fast food joint that got started in San Antonio, Texas in the early 1950s.

I also heard this old number by Eric Clapton, Going Down to the Crossroads.

Attack of the Giant Fried Rubber Chicken Livers!

Have you ever wondered if anyone ever made a movie about an attack on planet earth by fried rubber chicken livers? Boy, am I glad I’m not the only one. I suppose I could check the MeTV channel to if any such film was ever aired by Svengoolie.

What do you mean you never heard of Svengoolie?

I used to watch Svengoolie a long time ago. It’s this guy called Svengoolie, played by Rich Koz, who hosts really awful horror movies. I could watch them for about 10 minutes before I had to switch to something which wouldn’t bore me or make me gag—which I realize often can’t be done nowadays.

Svengoolie would make corny jokes and get rubber chickens thrown at him. That was actually the best part of the show.

Part of what made me think about this was reminiscing about the early 1970s when I lived at the YMCA and worked for a consulting engineer company called WHKS & Co.

You got a single sleeping room at the YMCA and there was no kitchen. Frankly, it was for old guys who had no place else to go and for young guys trying to find out how to go somewhere else.

I ate in cafes a lot. I also picked up a lot of Kentucky Fried Chicken take out. I realize it’s called KFC nowadays. But back in the 1970s you could openly buy a box of fried chicken livers as a side dish at KFC. I think I began eating them because they’re actually a pretty healthy food item if you prepare them right. You could get a generous serving of them. They were occasionally a little tough to chew—a little on the rubbery side.

You can’t get any franchise owners to admit they sell them now. You’ll see web articles that mention you can still get them at what they call certain “regional” stores. You can also maybe still get KFC chicken gizzards. Neither is on any official menu.

The connection here is fried tough chicken livers and bad old horror movies hosted by Svengoolie who makes corny jokes and dodges rubber chickens. I can easily imagine somebody making a throwback classic B Horror movie called “Attack of the Giant Fried Rubber Chicken Livers.”

Wouldn’t that be great?

Try watching Svengoolie sometime. You might not like the movie, but you’ll get a big kick out of Svengoolie.

The Friday Night Big Mo Blues Show

I heard this on ‘da Friday Night Blues on KCCK 88.3 earlier. I took guitar lessons when I was a kid. I was real good at buzzing the strings. Not everybody can make the audience clap their hands to their ears and howl in pain. It’s a rare talent-thank goodness. You’re welcome.

I heard Iowa Blues legend Kevin B.F. Burt tonight. I’ll never be able to prove it, but I think he was D.J. for KCCK Friday Blues Show for a short time in the distant past. I’m pretty sure I listened to him. I can’t find that in his interviews anywhere, not even in the biggest one I could find. Sena saw him and his wife at an optometrist clinic a few years ago. He was trying to pick up a pair of eyeglasses. He was in a big hurry and kept saying he had to get to his gig. Sena even spoke to him, asking him if he was Kevin Burt. He very kindly confirmed it-but he was still in a hurry.

KCCK Hand-Battered Catfish Lore

I listen to the KCCK radio station (88.3) Big Mo Blues Show on most Friday nights and the host is John Heim, aka Big Mo. He always mentions a sponsor he calls May Reese hand-battered catfish. There are a couple of slogans which make it sound real.

“It’s better because it’s battered!”

“It’s packed with nitrates!”

“Coming soon to a river near you!”

Nobody but Big Mo ever advertises it and I’m not even sure I’m spelling “May Reese” correctly. In fact, I doubt there is such a person. But it’s fun to listen to Big Mo talk about May Reese’s hand-battered catfish.

Sena bought some breaded catfish nuggets from Hy-Vee, which is about as close to May Reese as we’re likely to get. They’re IQF, which means Individually Quick Frozen. Sena’s just slightly dubious about trying them. But she’s going to cook them, just because Big Mo talks about hand-battered catfish (better because it’s battered!”) and it’s mainly because I get a kick out of the legendary May Reese.

We can’t remember ever eating catfish.  When I was a kid, I used to fish for bullhead, which are in the same family as catfish. In fact, they are sometimes called bullhead catfish, which I didn’t even know until today when I looked it up on the web.

I fished for them in a creek in East Park in Mason City where I grew up. I would catch them and throw them back. They were almost always small and sometimes one would manage to squirm enough to sting me with the very sharp spine on its fins.

I never brought bullhead home because Mom made it abundantly clear she would never clean them.

I doubt Sena would ever cook hand-battered bullhead, even if you could find them IQF in the grocery store.

I’m not sure if bullhead would be “packed with nitrates” and I don’t think May Reese would hand batter them—unless she used a baseball bat.

‘ay, this here be international talk like a gentleman o’ fortune day

The title of this post is a translation of “Hey, This is International Talk Like a Pirate Day.” I used a Pirate Speak translator to generate it.

Sena reminded me about this holiday, which got started back in 1995 by a couple of guys from Albany, Oregon.

She says she heard about it on the Mike Waters radio show this moring, Waters Wake-Up on the Iowa radio station KOKZ 105.7. Sena either heard Waters call it National Pirates Day or she misheard him. She also said that Waters denied that any pirates ever said “Arrr,” back in the heyday of pirates.

I beg to differ, arrr, Matey! The Wikipedia entry says that the dialect was real and probably was based on the dialect of sailors from West Country in the southwest corner of Britain.

Sena and I couldn’t find any holiday called National Pirates Day. I did find National Meow Like a Pirate Day, which, interestingly, is also a holiday today. It got started in 2015.

But the main event be international talk like a gentleman o’ fortune day—which I darn nearrr forgot!

I have a dim memory of writing a blog post using the pirate translator several years ago. It was on a different blog, which I canceled in 2018. I didn’t keep that particular post. I think the topic was teaching internal medicine doctors and medical students about delirium so that they would know when they actually need consultation from a psychiatrist.

So, in honor of International Talk Like a Pirate Day, I’m going to post a piratical translation of one of my similar posts from way back in 2011:

“Do ye ‘ave to be interested in psychiatry to volunteer fer the delirium prevention project?”

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

 they said that there the first an’ second yearrr students might want to volunteer—especially the ones interested in pursuin’ psychiatry as a career.

 now think about that there a minute. Why would ye necessarily need to be interested in psychiatry? ‘ere be a few facts:

1.Delirium be a medical emergency; it just ‘appens to mimic psychiatric illness because it’s a manifestation o’ acute brain injury.

 2.The most important treatment fer delirium be not psychiatric in nature necessarily; the goal be to find an’ fix the medical problems causin’ the delirium.

 3.Many experts in delirium ain’t psychiatrists; the authors o’ the new book “delirium in critical care”, valerie page an’ wes ely, ain’t psychiatrists—they’re intensivists.

 4.Some o’ the best teachers about delirium be geriatric nurse specialists an’ geriatricians.

 I thought that there by reachin’ aft further into a physician’s trainin’ career, I would find people less biased toward thinkin’ o’ delirium as a primary mental illness. It turns out that there bias runs deep in our medical education system.

 it isn’t that there psychiatrists shouldn’t be interested in studyin’ an’ ‘elpin’ to manage delirium. Psychiatrists, especially them specializin’ in psychosomatic medicine, be among the best qualified to inform other medical an’ surgical disciplines about the importance o’ recognizin’ delirium fer what it is—a medical problem that there threatens the brain’s integrity an’ resilience, raises the risk o’ mortality by itself regardless o’ the medical problems causin’ it, prolongs medical ‘ospitalization, an’ makes discharge to long term care facilities more likely, especially in the elderly.

 delirium be a problem fer doctors, not just psychiatrists. So it makes sense fer all medical students, regardless o’ their goals fer career specialty, to be interested in learnin’ about delirium.

 delirium be also a problem fer nurses, who frankly ‘ave led the way in education about delirium fer many years now. You’ll find few experts pointin’ to the american psychiatric association practice guidelines fer the treatment o’ delirium as the ultimate authority these days—because they’ve not been updated formally since 1999. All one ‘as to do be spell out “delirium prevention guidelines” in web browser search bars an’ choose from several sets o’ free, up-to-date guidelines that there be supported by the research evidence base in the medical literature to within a yearrr or two o’ the present day. Some o’ the best ones be authored by nurses.

 so maybe the pool o’ volunteers fer the delirium prevention multicomponent intervention might be nursin’ students.

 on the other ‘and, from what pool does the ‘ospital elder life program (help) recruit volunteers? an’ the australian resource center fer ‘ealthcare innovation multicomponent program, revive (recruitment o’ volunteers to improve vitality in the elderly, ‘ow do they do it?

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

‘appy international talk like a gentleman o’ fortune day, arr, matey!

Thoughts on Suicide Risk Assessment

I know the term “suicide risk assessment” sounds very clinical. That’s because I did it for many years as a consultation-liaison psychiatrist in the general hospital.

The human part of it was using the suicide safety plan, which I got from the Centre for Applied Research in Mental Health & Addiction (CARMHA). You can download it yourself and adapt it by writing in the National Suicide Prevention Lifeline: 988 Suicide and Crisis Lifeline. That’s because the phone numbers on the form are specific to Canada.

Most often I interviewed patients in the intensive care units, where they were admitted after a suicide attempt. The interviews were very short if they refused to talk to me or were still delirious—often the case.

If they were awake and able to converse, the interviews were often pretty long. One way to connect with the patient was working on the safety plan together. I was often able to tell whether they were sincere or not by the level of detail they gave me about support persons they could get in touch with or things they could do to help them cope with whatever was troubling them.

A lack of detail in the plan, or refusal to work on some parts of it were areas of concern. If there were comments about friends, pets, or pastimes that spontaneously led to laughter (yes, that happened occasionally!), I was more confident that the patient was able to look toward the future and make specific plans for staying alive.

There is healthy debate about how useful specific suicide risk assessment scales are for predicting and preventing suicide. They are an essential part of the computerized medical records now, whatever anyone thinks of their reliability at predicting imminent suicide. I never used no-suicide contracts because well before the time I entered professional practice, most experts agreed that they don’t prevent suicide.

What was more useful for me as a clinician was to sit down at the patient’s bedside and, after getting the details about what the patient actually did in the suicide attempt and the events connected with it (along with a comprehensive and thorough history), I would get the safety plan from my clipboard, hold it up so they could see it and say, “Now let’s work on this; it’s your safety plan.”

I can’t tell you how often working on those plans, frequently for more than half an hour, led to laughter as well as tears from the patient. When it worked, meaning the relationship between us deepened, I sometimes did not find it necessary to admit the person to the psychiatric ward. While this occasionally alarmed the ICU nurses, things usually turned out fine later.

What Happened to Miracle Whip?

Okay, the update on the Mayo vs Miracle Whip thing is not going as planned so far. A couple of days ago, we had tuna fish sandwiches using Miracle Whip.

This was not the Miracle Whip I knew growing up. Neither of us could appreciate much of a taste at all. It’s a crisis.

Even the label on the jar looks strange. Since when does Kraft call it “Creamy Mayo & Tangy Dressing?” Why do they need to use the word “Mayo?” And it didn’t have the tangy flavor I remember.

This is all because of aliens. I’m pretty sure this is a violation of the Intergalactic Federation for Preservation of Tanginess Standards (IFFPOTS). Look it up.

I never made Miracle Whip sandwiches with just Miracle Whip on two slices of bread. I also had a slice of lunch meat on them. In fact, I ate one Miracle Whip nitrate-rich lunch meat sandwich a day for lunch for years. Its’ a good thing scientists discovered that nitrates aren’t bad for you.

But the point is the Miracle Whip tasted tangy back in those days. What happened?

Maybe it’s because my taste buds are older. More likely it’s because aliens kidnapped me and altered my taste buds. Or maybe they altered the Miracle Whip itself.

We’re not done yet. There are other recipes to try.

What Would Make Psychiatry More Fun?

I just read Dr. George Dawson’s post “Happy Labor Day” published August 31, 2022. As usual, he’s right on the mark about what makes it very difficult to enjoy psychiatric practice.

And then, I looked on the web for anything on Roger Kathol, MD, FACLP. There’s a YouTube video of my old teacher on the Academy of Consultation-Liaison Psychiatry (ACLP) YouTube site. I gave up my membership a few years ago in anticipation of my retirement.

I think one of my best memories about my psychiatric training was the rotation through the Medical-Psychiatry Unit (MPU). I remember at one time he wanted to call it the Complexity Intervention Unit (CIU)—which I resisted but which made perfect sense. Medical, behavioral, social, and other factors all played roles in the patient presentations we commonly encountered with out patients on that unit where we all worked so hard.

Dr. Kathol made work fun. In fact, he used to read selections from a book about Galen, the Greek physician, writer and philosopher while rounding on the MPU. One day, after I had been up all night on call on the unit, I realized I was supposed to give a short presentation on the evaluation of sodium abnormalities.

I think Roger let me off the hook when he saw me nodding off during a reading from the Galen tome.

Dr. Dawson is right about the need to bring back interest, fun and a sense of humor as well as a sense of being a part of what Roger calls the “House of Medicine.” He outlines what that means in the video.

What made medicine interesting to me and other trainees who had the privilege of working with Roger was his background of training in both internal medicine and psychiatry. He also had a great deal of energy, dedication, and knew how to have fun. He is a great teacher and the House of Medicine needs to remember how valuable an asset a great teacher is.

%d bloggers like this: