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.

The Medical-Psychiatry Unit

I guess I’m incorrigible; there are now 4 eggs in the robins’ nest. Progress there reminded me of another kind of progress–in integrated health care.

On that note, this is just a brief update on the Medical-Psychiatry Unit (MPU). I thought it would be a good time to do this since a hard-working Pennsylvania psychiatrist notified me of the very successful Medical Complexity Unit (MCU) in operation at Reading Hospital. See my post from May 23, 2019.

I co-attended on our MPU for 17 years before I chose to concentrate on the Consultation-Liaison Psychiatry (CLP) service. The health insurance payer system challenges have probably not changed much. I still believe that the MPU is a great place to teach trainees to appreciate the rewards and challenges of caring for patients with complex, comorbid psychiatric and medical issues.

I hope the video makes the case for that. I decided it didn’t need a voice over. I welcome any comments and questions.

Brief News Item

I received exciting news from Dr. Kolin Good, M.D., a colleague in Reading, Pennsylvania. There is a thriving Medical-Psychiatry Unit (MPU) at Reading Hospital. Dr. Good consulted with The University of Iowa several years ago on how to get it started, since we have a 15 bed MPU.

They call it the Medical Complexity Unit (MCU) and the highlights of her message are:

“We now have 19 beds.

Nursing 1:4 ratio.

Staffing is 1 internist ( hospitalist) and 1 psychiatrist ( me) with a psychiatric social worker and physician’s assistant.

We have a LOS that is the same as other units of the hospital.

We have decreased 1:1’s throughout our entire hospital ( > 650  beds ).

We are a favorite rotation for training.

Most important: we provide excellent care for complex patients.”

Congratulations are in order!

Reading Hospital is also looking for a Consultation-Liaison Psychiatrist (although not to staff the MCU).

A former teacher of mine and a major mover and shaker in the integrated care effort is Dr. Roger Kathol, MD, the leader of Cartesian Solutions, Inc. Check his web site by googling the name. The credit goes to him, Dr. Good, and the rest of the Reading Hospital staff who made the MCU a reality.