Working With Families in Medical Settings provides mental-health professionals with the tools the... more Working With Families in Medical Settings provides mental-health professionals with the tools they need to figure out what patients and families want and how, within the constraints imposed by twenty-first century healthcare settings, to best give them the care they need. Psychiatrists and other clinicians who work in medical settings know that working with a patient with a chronic illness usually entails work with that patient's family as well as with other medical professionals. Some families need education; others have specific difficulties or dysfunctions that require skilled assessment and intervention. It is up to the clinician to find productive ways to work with common themes in family life: expressed emotion, levels of resilience, life-cycle issues, and adaptation to illness, among others. Enter Working With Families in Medical Settings, which shines a spotlight on the major issues professional caregivers face and shows them how to structure an effective intervention in all kinds of settings. Psychiatrists, particularly those in psychosomatic medicine, and other clinicians who work with the medically ill will find Working With Families in Medical Settings to be an essential resource and guide to productive relationships with patients and their families.
This article describes a specialized clinic for nonepileptic seizures. The clinic's program inclu... more This article describes a specialized clinic for nonepileptic seizures. The clinic's program includes individual therapy, family therapy, medication management, psychoeducational group therapy, and what? A. Mindfulness-based therapy. B. Psychodynamic group therapy. C. Continuous video EEG monitoring. D. Motivational interviewing with neurofeedback. "Dr. B," a consultation-liaison psychiatrist, was consulted on "Ms. A," a 24-year-old single pregnant white woman who had received a new diagnosis of nonepileptic seizures (NES). Although Ms. A's NES events began several years ago, the changing nature of her seizures led her neurologist to admit her to the epilepsy monitoring unit. Ms. A and her mother had described all the types of events that Ms. A experienced, from mild twitching of her right side to full body events. All her events were captured during her hospital stay, and no epileptiform activity was noted. Ms. A and her mother accepted the diagnosis, which was delivered by the neurologist on the epilepsy monitoring unit and followed up by a DVD created for patients with NES. Most patients have family members present at this time, making family inclusion a natural part of inpatient care. Recounting her history, Ms. A said, "A lot happened from when I was 4. I was molested by day care providers, my dad died, in total seven other people died. My mom was stalked, so she wouldn't let me play outside. I was stalked and harassed in fifth grade by a classmate. At age 13, I had PCOS [polycystic ovary syndrome], and they threw hormones at me. I heard voices to get a gun and shoot myself in the head. I was taken off all my meds.… I've had a diagnosis of depression since age 4, PTSD since age 15, bipolar disorder with depression from age 16, and borderline personality disorder. I was manic when I was a teenager, after more deaths, sexual assaults, and after a guy I knew committed suicide." Her history included eight inpatient psychiatric admissions, a year in residential care at age 16, and a family history significant for unspecified mental illness, addictions, and suicides. She has been on disability for 2 years continued See related features: CME course (p. 917) and AJP Audio (online)
Note the title of this book is Consultation-Liaison Psychiatry. To many people's surprise, when t... more Note the title of this book is Consultation-Liaison Psychiatry. To many people's surprise, when the seventh subspecialty in psychiatry was born in 2001, it was named "psychosomatic medicine." This name, or misnomer, is the subject of much discussion by Dr. Lipsitt. Broadly speaking, physicians practicing in medical settings favor the term consultation-liaison psychiatry, while researchers and historians favor psychosomatic medicine.
Medical student mistreatment is a significant problem. After graduation, medical students report ... more Medical student mistreatment is a significant problem. After graduation, medical students report their perceptions of prior mistreatment on the Association of American Medical Colleges Medical School Graduation Questionnaire (GQ). In 2013 the percentage of students who reported having been "publicly embarrassed" was 47.2 percent, and 23.3 percent reported being "publicly humiliated" [1]. Both medical schools and hospital systems are mandated to address mistreatment effectively. A Liaison Committee on Medical Education accreditation standard mandates that "a medical education program must define and publicize the standards of conduct for the faculty-student relationship and develop written policies for addressing violations of those standards" [2], and the Joint Commission's leadership standards specify that organizations must "provide skills-based training and coaching for all leaders and managers in relationship-building and collaborative practice, including skills for giving feedback on unprofessional behavior, and conflict resolution" [3]. However, there is a lack of evidence of best practice for prevention and management of mistreatment and inappropriate behavior. Current dedicated attempts to make changes in physician practice have failed. A 12-year study at the David Geffen School of Medicine at UCLA-which included informal and formal mechanisms of reporting and resolving incidents of mistreatment; education for students, residents, and faculty; and open discussion of the topic at all levels-failed to decrease the GQ reports of mistreatment [4]. New ways of thinking about, identifying, and responding to mistreatment are urgently needed. Formal CME activities have little effect on physician behavior [5]. In contrast, interactive CME sessions that provide an opportunity to practice skills are successful at producing change in professional practice [4]. Interactive, experiential learning has been gradually seeping into medical education at both the student and faculty levels. This article promotes the use of experiential learning, specifically role play, to address student mistreatment in medical education and in hospital settings. The goal of role play is to develop scenarios and scripts that teach faculty, residents, and students how to recognize, address, and prevent mistreatment. What Is Role Play? Role play is one type of simulation that focuses attention on the interactions between people.
ABSTRACT: As Vice Chair of Clinical Services of Psychiatry at the University of Colorado, I choos... more ABSTRACT: As Vice Chair of Clinical Services of Psychiatry at the University of Colorado, I choose to work where clinical services need most attention. As a woman, I want to show up where we can be seen and show up in the best possible way. Just as COVID began, I found myself doing clinical shifts in the newly created psychiatry emergency room. I became part of a front-line team, where “I” became “We,” facing an unknown enemy. Not only was my work life upended, but my personal life was too, as I rushed to help my daughter, a medical student, care for her son when his day-care closed. My commentary highlights the increased burden experienced by women during this time, an example of systemic bias in medicine.
Working With Families in Medical Settings provides mental-health professionals with the tools the... more Working With Families in Medical Settings provides mental-health professionals with the tools they need to figure out what patients and families want and how, within the constraints imposed by twenty-first century healthcare settings, to best give them the care they need. Psychiatrists and other clinicians who work in medical settings know that working with a patient with a chronic illness usually entails work with that patient's family as well as with other medical professionals. Some families need education; others have specific difficulties or dysfunctions that require skilled assessment and intervention. It is up to the clinician to find productive ways to work with common themes in family life: expressed emotion, levels of resilience, life-cycle issues, and adaptation to illness, among others. Enter Working With Families in Medical Settings, which shines a spotlight on the major issues professional caregivers face and shows them how to structure an effective intervention in all kinds of settings. Psychiatrists, particularly those in psychosomatic medicine, and other clinicians who work with the medically ill will find Working With Families in Medical Settings to be an essential resource and guide to productive relationships with patients and their families.
This article describes a specialized clinic for nonepileptic seizures. The clinic's program inclu... more This article describes a specialized clinic for nonepileptic seizures. The clinic's program includes individual therapy, family therapy, medication management, psychoeducational group therapy, and what? A. Mindfulness-based therapy. B. Psychodynamic group therapy. C. Continuous video EEG monitoring. D. Motivational interviewing with neurofeedback. "Dr. B," a consultation-liaison psychiatrist, was consulted on "Ms. A," a 24-year-old single pregnant white woman who had received a new diagnosis of nonepileptic seizures (NES). Although Ms. A's NES events began several years ago, the changing nature of her seizures led her neurologist to admit her to the epilepsy monitoring unit. Ms. A and her mother had described all the types of events that Ms. A experienced, from mild twitching of her right side to full body events. All her events were captured during her hospital stay, and no epileptiform activity was noted. Ms. A and her mother accepted the diagnosis, which was delivered by the neurologist on the epilepsy monitoring unit and followed up by a DVD created for patients with NES. Most patients have family members present at this time, making family inclusion a natural part of inpatient care. Recounting her history, Ms. A said, "A lot happened from when I was 4. I was molested by day care providers, my dad died, in total seven other people died. My mom was stalked, so she wouldn't let me play outside. I was stalked and harassed in fifth grade by a classmate. At age 13, I had PCOS [polycystic ovary syndrome], and they threw hormones at me. I heard voices to get a gun and shoot myself in the head. I was taken off all my meds.… I've had a diagnosis of depression since age 4, PTSD since age 15, bipolar disorder with depression from age 16, and borderline personality disorder. I was manic when I was a teenager, after more deaths, sexual assaults, and after a guy I knew committed suicide." Her history included eight inpatient psychiatric admissions, a year in residential care at age 16, and a family history significant for unspecified mental illness, addictions, and suicides. She has been on disability for 2 years continued See related features: CME course (p. 917) and AJP Audio (online)
Note the title of this book is Consultation-Liaison Psychiatry. To many people's surprise, when t... more Note the title of this book is Consultation-Liaison Psychiatry. To many people's surprise, when the seventh subspecialty in psychiatry was born in 2001, it was named "psychosomatic medicine." This name, or misnomer, is the subject of much discussion by Dr. Lipsitt. Broadly speaking, physicians practicing in medical settings favor the term consultation-liaison psychiatry, while researchers and historians favor psychosomatic medicine.
Medical student mistreatment is a significant problem. After graduation, medical students report ... more Medical student mistreatment is a significant problem. After graduation, medical students report their perceptions of prior mistreatment on the Association of American Medical Colleges Medical School Graduation Questionnaire (GQ). In 2013 the percentage of students who reported having been "publicly embarrassed" was 47.2 percent, and 23.3 percent reported being "publicly humiliated" [1]. Both medical schools and hospital systems are mandated to address mistreatment effectively. A Liaison Committee on Medical Education accreditation standard mandates that "a medical education program must define and publicize the standards of conduct for the faculty-student relationship and develop written policies for addressing violations of those standards" [2], and the Joint Commission's leadership standards specify that organizations must "provide skills-based training and coaching for all leaders and managers in relationship-building and collaborative practice, including skills for giving feedback on unprofessional behavior, and conflict resolution" [3]. However, there is a lack of evidence of best practice for prevention and management of mistreatment and inappropriate behavior. Current dedicated attempts to make changes in physician practice have failed. A 12-year study at the David Geffen School of Medicine at UCLA-which included informal and formal mechanisms of reporting and resolving incidents of mistreatment; education for students, residents, and faculty; and open discussion of the topic at all levels-failed to decrease the GQ reports of mistreatment [4]. New ways of thinking about, identifying, and responding to mistreatment are urgently needed. Formal CME activities have little effect on physician behavior [5]. In contrast, interactive CME sessions that provide an opportunity to practice skills are successful at producing change in professional practice [4]. Interactive, experiential learning has been gradually seeping into medical education at both the student and faculty levels. This article promotes the use of experiential learning, specifically role play, to address student mistreatment in medical education and in hospital settings. The goal of role play is to develop scenarios and scripts that teach faculty, residents, and students how to recognize, address, and prevent mistreatment. What Is Role Play? Role play is one type of simulation that focuses attention on the interactions between people.
ABSTRACT: As Vice Chair of Clinical Services of Psychiatry at the University of Colorado, I choos... more ABSTRACT: As Vice Chair of Clinical Services of Psychiatry at the University of Colorado, I choose to work where clinical services need most attention. As a woman, I want to show up where we can be seen and show up in the best possible way. Just as COVID began, I found myself doing clinical shifts in the newly created psychiatry emergency room. I became part of a front-line team, where “I” became “We,” facing an unknown enemy. Not only was my work life upended, but my personal life was too, as I rushed to help my daughter, a medical student, care for her son when his day-care closed. My commentary highlights the increased burden experienced by women during this time, an example of systemic bias in medicine.
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