xxAACP Newsletter, Volume 15, Number 2, Spring 2001
PRESIDENT'S COLUMN
The Next Generation
I live this fantasy that I will always remain young and energetic (although my pre-adolescent son is quickly shoving me toward the grave), and that I will always be here to do what I do at work. The reality is that I could get hit by a car tomorrow (G-d forbid) or win a lottery ticket (would I really stop working?)..and yes, eventually will retire. Who will be there to do what I do? Is what I do worth continuing? If it is, how do I help/create/encourage the generation that follows me? How do we engender that passion we now hold in those with whom we work and teach, so they will want to do the work we do? How do we "sell" public/community psychiatry?
I would suggest a multitude of strategies:
a) Make it real:. My lecture to first year medical students (where I am given an hour to teach them everything they need to know about schizophrenia (?!?)) touches on epidemiology, genetics, neurotransmitters, and diagnosis; however, the focus of the talk is on Albert, a patient with schizophrenia, the impact of the illness on his life, the bio-psycho-social approaches we as a team (with Albert as a partner) took to maximize his recovery, and re-integration into society. I take my residents on community outreach to shelters and boarding homes and the jail, so when they are turfing someone back they know where they are sending them (and why patients are sometimes so loathe to return there and would do anything for that not to happen). I have my residents attend the local NAMI meeting to get a brief flavor of what it must be like to be a family member. I have a consumer panel speak with my residents, medical students, and other trainees about how they think we can do our job better, be more responsive to their needs. I have my medical students ride with case managers, and spend time working in a homeless shelter. Oh heck, why stop with trainees? Recently I did a preceptorship for drug reps called "Putting a Face on Schizophrenia". We spent two hours hearing about brain structure and neurotransmitters, but spent the rest of the day talking with patients who told of their life experiences, and a NAMI member speaking of how schizophrenia had affected the life of her family and her son (and all were paid for their contribution). Each one of these offers the "audience" the opportunity to see first hand the nature of our practice, and how complicated and challenging it can be.
b) Show them the rewards: Every day my residents are reminded of the importance of their work, be it a smile from the abused woman now in therapy and in a safe stable home, or the man who got disability based on their efforts at advocacy. Their involvement in the building of a Habitat for the Homeless project (co-sponsored by COMPEER and a pharmaceutical company) allows them to better understand the impact of homelessness AND home-ownership for someone with mental illness. They find themselves blessed with an abundance of patients who inspire them with kindnesses, courage, and persistence in the face of horrid adversity. And for most it is gratifying to discover that caring for the patient populations with whom we partner is not easy, but is challenging, intriguing work that requires patience, diligence, energy, optimism, and a capacity to weave technical expertise with neurobiology with finely tuned therapeutic skills and systems understanding.
c) Duct tape works well: Community psychiatrists don’t treat just patients, they treat systems of care, systems of care which are often woefully lacking in their capacity to offer support for a population in need. Many practitioners avoid these kinds of systems and issues like the plague because the process of advocacy and change is slow, arduous, and often frustrating; this kind of practice is not for the faint-hearted, but rather for the brave. The community psychiatrist enjoys engaging in battle, loves being perched atop the high moral ground, but is crafty and creative enough to scavenge with whatever tools are possessed to get the job done. Show your trainees how "duct tape" can jerry rig pert near anything, and how systems CAN respond to advocacy.
You show them your passion, and the fun, and gratification of having an impact on someone’s life. You model compassion, and small successes, and strategies to change systems of care. You act in a responsible leadership role, and you never, never stop advocating for what is right. People come to community psychiatry because it the most challenging sector of psychiatry, because we must work in partnerships using a variety of inventive tools, because we love tilting at windmills, and because we know we can make a difference. Showing our trainees these things will help us recruit and retain the next generation of community psychiatrists.
President, AACP
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