Letter from a Pragmatic Idealist

Blog Post by James J. Amos MD, University of Iowa, USA

I read with interest an article from The Hospitalist, August 2008 discussing the Center for Medicare and Medicaid Services (CMS) requirement for hospitals to submit information on Medicare claims regarding whether a list of specific diagnoses were present on admission (POA)[1]. The topic of the article was whether or not delirium would eventually make the list of diagnoses that CMS will pay hospitals as though that complication did not occur, i.e., not pay for the additional costs associated with managing these complications. At the time this article was published, CMS was seeking public comments on the degree to which the conditions would be reasonably preventable through application of evidence-based guidelines. I have no idea whether delirium due to any general medical condition made the list or not. But I have a suggestion for a delirium subtype that probably should make the list, and that would be intoxication delirium associated with using beverage alcohol in an effort to treat presumed alcohol withdrawal.

Core Competencies and the Psychosomatic Medicine “Supraspecialty”

Blog Post by James J. Amos MD, University of Iowa, USA 

At the annual Academy of Psychosomatic Medicine (APM) meeting this year held on Marco Island, Florida, I heard Dr. Theodore Stern call Psychosomatic Medicine (PM) a “supraspecialty”. Usually it’s described as a subspecialty.  I couldn’t find the word in Webster’s although “supra” comes from the Latin for “above, beyond, earlier”. One of the definitions is “transcending”.  I tried to Google “supraspecialty” and came up empty. So I guess it’s a neologism. The context was a workshop on how to enhance resident and medical student education on Psychosomatic Medicine services. Dr.  Stern coined the term while talking about the scope of practice of PM. As he went through the long list, it gradually dawned on me why “supraspecialty” as a title probably fits our profession, mainly because it makes us, as psychiatrists, accountable for aspects of general and specialty medical and surgical care above and beyond that of Psychiatry alone.

Inpatient psychiatry

Blog Post by Michael Casher, MD, Director, Psychiatry Adult Inpatient Program, Clinical Assistant Professor, Department of Psychiatry, University of Michigan Medical School

Inpatient psychiatry may yet join consultation psychiatry (psychosomatic medicine) as a subspecialty within American psychiatry in the future.  There is a growing movement within many branches of medicine for “hospitalists”, physicians who spend the majority of their time taking care of hospitalized patients.  This is especially common now in the U.S. in the fields of internal medicine, pediatrics, and neurology, but there are now beginning to be a number of psychiatric hospitalists as well, including many in academic centers.  Inpatient psychiatry encompasses treatment of virtually all of the serious/severe mental disorders.  In our experience on a university-based psychiatric unit, we see quite a few patients with mood disorders and psychotic disorders, as well as borderline PD patients in crisis.  We also frequently take care of geropsychiatric patients with depression or dementia-related agitation.

Strange psychiatric consultation questions I have known

Blog Post by James J. Amos MD, University of Iowa, USA 

In a recent blog I mentioned the “wailing wall” of strange and difficult to answer psychiatry consultation questions sometimes asked by our non-psychiatry colleagues from internal medicine and surgery (blog post Amos 10/14/2010). Questions are sometimes ambiguous and often need to be reframed so that the Psychosomatic

The Stolen Book

Blog Post by James J. Amos MD, University of Iowa, USA  

What I wanted to do as I took over the psychiatry consultation service this month was to highlight the usefulness of our newly published book Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry.  I planned to refer to the first chapter on consultation process in order to highlight the importance of clarifying the consultation question. When I asked the residents whether they’d yet seen the copy that I’d donated to the Staff Consult Office a couple of months ago, they said indeed they had, found it useful, and held it up for me to see.

The Customer is Always Partly Right

Blog Post by James J. Amos MD, University of Iowa, USA  

Recently our Psychosomatic Medicine/Consultation Psychiatry (PM/CLP) service received a request to evaluate a patient on the Bone Marrow Transplantation (BMT) inpatient unit. There are no worries about revealing personally identifying characteristics of the patient. The issue was general enough to apply to many thousands of patients and inpatient general and specialty medical units everywhere. As the BMT specialist saw it, the patient was severely depressed and needed an antidepressant. As the patient saw it according to the junior psychiatry resident, depression was not the issue and antidepressant was unnecessary and unwanted, adding that nearly all of the vegetative symptoms of fatigue, appetite and sleep disturbance as well as other somatic suffering could be explained by the medical illness and its treatment. After the resident’s excellent presentation and my visit, there seemed to be no difficulty. The patient simply denied feeling depressed and declined the offer of antidepressant. Aside from the vague sense I got that the patient was indifferent even to visits from our psychiatric nurses, I had no reason to doubt the resident’s conclusion, which was that supportive psychotherapy from psychiatric nurses continue and to call us back if there were a change.

‘Classic.’ A book which people praise but don’t read—Mark Twain

Blog Post by James Amos, MD, The University of Iowa Hosp and Clinics

When I announced the publishing of our book, Psychosomatic Medicine, An Introduction to Consultation-Liaison Psychiatry,  someone said that it’s good to finally get a book into print and out of one’s head.  The book in earlier years found other ways out of my head, mainly in stapled, paper clipped, spiral bound, dog-eared pages of  homemade manuals, for use on our consultation serviceIt’s a handbook and meant to be read of course, but quickly and on the run. As I’ve said in a previous blog, it makes no pretension to being the tour de force textbook in  America  that inspired it. However, any textbook can evolve into an example of Twain’s definition of a classic.  The handbook writer is a faithful and humble steward who can keep the spirit of the classic lively.

Baptism for a Lightweight

Blog Post by James J. Amos, Staff Psychiatrist, Dean Medical Center, Madison, Wisconsin, USA

I was rearranging my Psychosomatic Medicine reference books the other day. My library has 3 main heavyweights—literally. I recall the review by Donald Kornfeld and Ralph Wharton in the 2005 issue of Psychosomatics of the American Psychiatric Publishing Textbook of Psychosomatic Medicine, published in 2005. He tempered his praise for the work by noting that the book contained over a 1000 pages and weighed nearly 7 pounds and saying “The weightiness of our specialty need not be demonstrated by the heft of our textbooks…”

Who’s a “Psychosomaticist?”

Blog Post by James J. Amos, Staff Psychiatrist, Dean Medical Center, Madison, Wisconsin, USA

As co-editor of a forthcoming introductory handbook on Psychosomatic Medicine, I was trying to track down our contributors in order to send an e-mail update on progress in the production phase. I also wanted to invite them to submit an article to this blog site. I noticed that one of the contributors who’d been enrolled in a Psychosomatic Medicine fellowship is now identified as a “Psychosomaticist”. I’ve always been a little ambivalent about the name “Psychosomatic Medicine” anyway, but I have to admit I cringed when I saw one of our newer practitioners labeled a Psychosomaticist. I get the same feeling whenever I hear “somaticizer”. I’ll never forget what a presenter said about the term a few years ago at the annual meeting of the Academy of Psychosomatic Medicine (APM): “And by the way, it’s not ‘somaticizer’, it’s “somatizer”!” Is it?