Developing, Losing, and Regaining Trust in the Doctor-Patient Relationship.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

Improving child and adolescent psychiatry education for medical students: an inter-organizational collaborative action plan.

OBJECTIVE: A new Child and Adolescent Psychiatry in Medical Education (CAPME) Task Force, sponsored by the Association for Directors of Medical Student Education in Psychiatry (ADMSEP), has created an inter-organizational partnership between child and adolescent psychiatry (CAP) educators and medical student educators in psychiatry. This paper outlines the task force design and strategic plan to address the long-standing dearth of CAP training for medical students. METHOD: The CAPME ADMSEP Task Force, formed in 2010, identified common challenges to teaching CAP among ADMSEP's CAPME Task Force members, utilizing focus-group discussions and a needs-assessment survey. The Task Force was organized into five major sections, with inter-organizational action plans to address identified areas of need, such as portable modules and development of benchmark CAP competencies. RESULTS/CONCLUSION: The authors predict that all new physicians, regardless of specialty, will be better trained in CAP. Increased exposure may also improve recruitment into this underserved area.

An approach to the psychosocial treatment of the medically ill patient.

This article discusses some of the practices of psychosocial treatment. Broadly speaking, these practices include an emphasis on the doctor-patient relationship, the creation of a sound and lasting alliance, and the experience of trust and partnership that the physician fosters in helping the patient to negotiate the complex and uniquely individual experience of being ill. An argument is proposed that unless practitioners of medicine are mindful of the threats to the way they would like and are expected by their patients to practice medicine, they are unlikely to endorse changes actively or to pass the need for these changes onto the next generation of physicians. In this sense, keeping these concerns alive and the subject of ongoing discussion is crucial to the ongoing conceptualization of what it means to be a doctor.

Using a Socratic dialogue to tackle thorny issues of psychiatry.

Medical students often experience significant cognitive dissonance as they attempt to understand psychiatry. After the security of lab values and medical tests that characterize much of medical practice, the ambiguity of seemingly subjectively obtained information characteristic of psychiatry often leaves students somewhat uncomfortable with how psychiatric diagnoses are made and understood. This is, at its root, an issue of epistemology: How do we know what we say we know? Psychiatry can seem "fuzzy" to medical students, and it behooves psychiatry educators to explicitly address this discomfort but, at the same time, not apologize for the differences between psychiatry and "the rest of medicine." In this article, the author strives to emphasize that this kind of epistemological challenge is ancient and esteemed, represented to some extent in the writings of Plato (who believed that we measure the world by comparing our experience with our innate sense of what we know is true) and Aristotle (who insisted that what we know is based largely on what we can measurably experience). Using humor, an imagined conversation among these ancient philosophers and a modern psychiatrist-medical educator might help to dispel some of the discomfort that psychiatry education sometimes engenders among future physicians. The author presents an example of such a conversation. After a brief discussion of the epistemological differences characteristic of Platonic and Aristotelian views, students could be shown a script similar to the example script and then asked to discuss and debate the arguments elucidated. Perhaps even better, students could be asked to write their own debates based on how Plato or Aristotle would be expected to behave.