Front Matter

Contributors

Preface

Acknowledgments

PART I

Framework

1 The Hospitalist Model in Psychiatry

Laura Hirshbein, M.D., Ph.D.

2 Inpatient Services

Michael D. Jibson, M.D., Ph.D.

3 Consultation-Liaison Psychiatry

Sarah Mohiuddin, M.D.

Wael Shamsedeen, M.D.

PART II

Skill Set

4 Training and Background

Gerald Scott Winder, M.D., M.Sc.

5 Career Development in the Hospital Setting

Michael D. Jibson, M.D., Ph.D.

6 Leadership and Administration

Laura Hirshbein, M.D., Ph.D.

Bradley Stilger, M.D.

7 Teaching and Supervision

Michael Casher, M.D.

PART III

Clinical Care

8 Initial Assessment and Treatment Planning

Heather E. Schultz, M.D., M.P.H.

9 Diagnostic and Treatment Modalities

Joshua Bess, M.D.

10 Guidelines, Algorithms, and Order Sets

Michael D. Jibson, M.D., Ph.D.

11 Acute Disorders

Heidi Combs, M.D., M.S.

Paul R. Borghesani, M.D., Ph.D.

12 Transitions in Care, Documentation, and Interdisciplinary Communication

Michael D. Jibson, M.D., Ph.D.

13 Discharge and Transition to Outpatient Care

Stephen Mateka, D.O.

Sarah Mohiuddin, M.D.

PART IV

Special Issues

14 Legal and Ethical Issues

Ahmad Shobassy, M.D.

15 Quality Assessment and Improvement

Nasuh Malas, M.D., M.P.H.

16 Patient Safety

Katrina Bozada, M.D.

Laura Hirshbein, M.D., Ph.D.

17 Adverse Events

Michael D. Jibson, M.D., Ph.D.

Index

Medical Director, Seattle Neuropsychiatric Treatment Center, Seattle, Washington

Associate Professor of Psychiatry and Behavioral Sciences, Harborview Medical Center and University of Washington School of Medicine, Seattle, Washington

Assistant Professor of Psychiatry, University of Michigan, Ann Arbor, Michigan

Associate Emeritus Professor of Psychiatry, University of Michigan, Ann Arbor, Michigan

Professor of Psychiatry and Behavioral Sciences, Harborview Medical Center and University of Washington School of Medicine, Seattle, Washington

Professor of Psychiatry and History, University of Michigan, Ann Arbor, Michigan

Professor of Psychiatry, University of Michigan, Ann Arbor, Michigan

Associate Professor of Psychiatry and Pediatrics, University of Michigan, Ann Arbor, Michigan

Medical Director, Inspira Bridgeton Child & Adolescent Psychiatry Services, Merchantville, New Jersey

Assistant Professor of Psychiatry, University of Michigan, Ann Arbor, Michigan

Assistant Professor of Psychiatry, University of Michigan, Ann Arbor, Michigan

Assistant Professor of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon

Assistant Professor of Psychiatry, University of Michigan, Ann Arbor, Michigan

Assistant Professor of Psychiatry, University of Michigan, Ann Arbor, Michigan

Associate Professor of Psychiatry and Surgery, University of Michigan, Ann Arbor, Michigan

We are the keepers of hope.

Hospitalist psychiatry as a career choice alongside other “intensivist” specialties is still struggling to be given serious consideration. Outside of large multiunit long-term facilities, hospital care in both academic and community settings generally has been envisioned as not quite an afterthought but at least not a core component of clinical work. Traditionally, the community psychiatrist’s morning rounds on inpatients otherwise managed by nurses and activity therapists merely opened the day as a task to be handled before the more germane work of the outpatient clinic. The academician’s one dreaded month each year when research had to be set aside to satisfy the demands of the department seemed a necessary but unpleasant distraction from the tenure-yielding pursuits of the laboratory. Only recently have we seriously questioned those models.

Three decades ago, I came to the realization that I enjoyed two professional activities above all others—teaching and high-acuity clinical care. Through a fortuitous turn of events, I found my way to the perfect career, with a full clinical load of inpatients and a substantive role in medical education. My satisfaction with those activities has never waned, but the world around me has changed. Much has been written about the decreasing availability, in both beds and hospital days, of hospital-based care, but that is not the change that I find most interesting. Instead, I am fascinated and gratified by what has happened among the psychiatrists who choose to work in the hospital setting.

Gradually but steadily, I have been surrounded by a cadre of colleagues whose professional lives, like mine, never leave the hospital. They are mostly young, often coming straight from residency or fellowship, sometimes set in their directions and sometimes just trying things out. They have but one common quality: an interest in the most acute patients, most intense treatments, and most dynamic interactions in the field. As students, they learned the basics of psychopathology, clarified for them by its most florid presentations. As residents, they learned the skills of treatment, guided by the shoulder-to-shoulder tutelage of their faculty. Yet as early career psychiatrists in this seemingly familiar setting, they struggle to navigate the more subtle aspects of this professional path, often without the benefit of an appropriate mentor.

This book was conceptualized for these newcomers to the field. My fellow authors and I wrote the advice that we would give to a junior colleague launching a career in hospital-based psychiatry. The result turned out more generally applicable than that, with insights and recommendations that even I as an experienced hospitalist find enlightening and refreshing. With a few exceptions, this book is not about the clinical aspects of hospital care but rather about the skills and perspectives that allow us to provide that care and flourish professionally in the process.

It is my hope that armed with these tools, you will find your way through the myriad challenges, both clinical and practical, that make this work so daunting. I also hope that this book will convey some of the excitement and satisfaction that come uniquely through the hospital setting. I will add, just as I do with every student and resident on the first day of their clinical rotations, when their long preparation in the lecture hall and the library gives way to the moment they can walk through our doors to be part of a world they had only imagined, “Welcome to the hospital psychiatry service. This will be an experience like no other.”

It is with tremendous gratitude that I acknowledge three types of contributors to this book. First, I am grateful to my coauthors for their great faith and outstanding work in producing their chapters. I appreciate their insights, their efforts to make them accessible to us all, and their patience in the protracted process of publication.

Second, I am grateful to Laura W. Roberts, M.D., M.A., the long-suffering and ever-encouraging editor-in-chief of American Psychiatric Association Publishing. Without her inspired combination of prodding and praise, this project would have foundered on the shoals of my sometimes-flagging efforts.

Third, I feel continued kinship and appreciation for the primary mentors who guided me through the painful days of my inpatient apprenticeship—most notably, C. Peter Rosenbaum, M.D.—who stood beside me in the trenches of my internship day after day, gently reflecting on my efforts in the work we shared and modeling the skills he acquired over a long and distinguished career. I have not forgotten the many conversations we had in the respite of an umbrella-shaded table in the yard outside the inpatient unit in the hinterlands of Stanford Hospital. I am similarly grateful to the staff of the late “flight deck” at the Palo Alto VA Medical Center, where I spent my first few months as an inpatient attending (on the same unit where Ken Kesey had worked 30 years before), who tolerantly guided me into that role. I likewise appreciate my University of Michigan mentors—most notably, John F. Greden, M.D., who as chair took a chance on a not particularly promising young faculty candidate, and Rajiv Tandon, M.D., whose breadth of knowledge, passion for the work, and ceaseless mentoring made my first faculty years a period of unparalleled growth. Finally, I am grateful to the hospital nursing, social work, and activity therapy staff at University of Michigan Hospital who so capably exemplify the highest ideals of professionalism and service, as reflected in the insightful words of Valerie Barrie, R.N., B.S.N., at her (first) retirement. Those words inspire me every day.