TY - JOUR
T1 - A very modest proposal for 1990s C L psychiatry
AU - Weiner, Myron F.
AU - Sadler, John
AU - Fenton, Barry J.
AU - Fitzpatrick, Michael C.
AU - Crowder, J. Douglas
AU - Goodkin, Karl
N1 - Funding Information:
Interdisciplinary research involvement began with consultation and was enhanced through faculty members’ specialization, their flexibility of response, and their sensitivity to shared clinical problems. Interdisciplinary research in turn increased the use of psychiatrists as consultants. We began by providing practical consultation advice and by stimulating curiosity about patient management. When possible, the psychiatric consultation included attending-to-attending interaction. For example, our surgery attending engaged the surgery staff in considering the relationship between family structure and outcome of ICU treatment and has initiated a similar study in the burn unit. A study of the impact of support groups on women treated for breast cancer also involved surgeons in addressing the emotional needs of their patients. Specialization of the C/L attendings also helped them to develop a reputation in the community that generated referral of patients with specific problems and funding for specific research projects. For example, our surgical liaison’s work on support groups for breast cancer patients has been assisted and funded by the American Cancer Society. Our neurologic/neurosurgical liaison was enlisted by the neurosurgical staff in assessing presurgical and postsurgical issues in patients receiving adrenal medullary transplants for Parkinson’s disease. In-hospital and community contacts played a role in the development of that relationship. Our neurologic liaison had had experience in managing the psychiatric complications of Parkinson’s disease. Thus, being approached by the neurosurgeon and neurologist was a natural consequence. Moreover, his patient education efforts had made him known to the Dallas Area Parkinson Society, which also recommended him when the organization was approached for funding by the neurosurgical and neurologic staff. Another C/L faculty member’s interest in groups led to a series of publications on support groups for nurses and an institutionally funded collaboration with a pediatrician on the effects of support groups on neonatal ICU care. Flexibility in responding to the changing needs of the medical community was essential. One C/L attending made himself available as part of a Robert Wood Johnson-funded geriatric assessment team. When the grant expired, the portion of his salary that had been funded from the grant was underwritten by the hospital. Another C/L attending re-
Funding Information:
Psychiatric faculty physicians are full-time employees of Southwestern Medical School. The C/L faculty members’ direct supervision of patient care at Parkland, including on-site teaching of residents and medical students, requires about 10 hours per week per faculty member. The remainder of their time is spent in other academic activities, research, and direct care of private patients. Faculty members’ salaries are derived from various combinations of state funds, Parkland funds, private practice income, contractual income, and grants. All faculty members receive some state salary. Two are partially funded by Parkland. All have private practice income credited toward their salary. Two have contracts to do special work for the federal government (FBI and Worker’s Compensation) and one has partial salary support from an NIH research grant. The income derived from charges made to Parkland patients flows to the Department. Our collection rate at Parkland is 25% (higher than the psychiatric inpatient unit or outpatient clinic), but our C/L Service income has never exceeded $30,000 in 1 year.
PY - 1989/7
Y1 - 1989/7
N2 - The prediction that consultation-liaison psychiatry would play an integral role in the management of all medical/surgical patients in large hospitals has not come to pass. The primary reason is that no adequate funding mechanism has ever been found to support such a large endeavor. The economic climate as we enter the 1990s makes such funding even less likely. The authors suggest that C L psychiatry accept a lesser role, largely confined to teaching hospitals. That role, which has been successful at a large public teaching hospital for nearly 10 years, encompasses serving as a primary psychiatric teaching site for medical students, a primary teaching site for psychiatry residents and other postgraduate physicians rotating through psychiatry, a source of innovative dispositions for medically ill psychiatric patients, and a source of opportunity for interdisciplinary research.
AB - The prediction that consultation-liaison psychiatry would play an integral role in the management of all medical/surgical patients in large hospitals has not come to pass. The primary reason is that no adequate funding mechanism has ever been found to support such a large endeavor. The economic climate as we enter the 1990s makes such funding even less likely. The authors suggest that C L psychiatry accept a lesser role, largely confined to teaching hospitals. That role, which has been successful at a large public teaching hospital for nearly 10 years, encompasses serving as a primary psychiatric teaching site for medical students, a primary teaching site for psychiatry residents and other postgraduate physicians rotating through psychiatry, a source of innovative dispositions for medically ill psychiatric patients, and a source of opportunity for interdisciplinary research.
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U2 - 10.1016/0163-8343(89)90067-4
DO - 10.1016/0163-8343(89)90067-4
M3 - Article
C2 - 2744425
AN - SCOPUS:0024397472
SN - 0163-8343
VL - 11
SP - 231
EP - 234
JO - General Hospital Psychiatry
JF - General Hospital Psychiatry
IS - 4
ER -