Resident Update

What was most heroic to me was that she kept fighting amidst getting knocked down by every health crisis known to man, and still wanted to keep working. I would ask her why she kept doing it and she said that her patients were in crisis and they needed her. She told me it would always be worse for other people.

My friend Camille passed suddenly at the age of 59 on August 6, 2020. Her husband Vernon Francis and her two sons, Anthony and Nicolas, were her life. What made her a hero to me was that she gave of herself even at times when she did not have enough to give. She did it without wanting to be acknowledged. The world has lost another nameless warrior dedicated to causes bigger than herself until her last breath. I will miss her dearly.

My biggest hero has and always will be my father. Although he will never be a household name, he instilled all of the values that you look for in a hero: fierceness and loyal, morally sound, dedicated to doing what is right, regardless if he took flack for it. He told us to “do it right the first time” and not to shortchange ourselves, regardless of how people treated us. Family was always his top priority, doing whatever it took to put food on the table or to ensure we had whatever we “needed” not necessarily wanted. Most importantly, he taught us to abide by a few key principles including: 1) try to be kind to everyone (regardless how they treat you); 2) stand up for yourself because it is not guaranteed others will do it for you; 3) stand up for those who will not stand up for themselves; 4) carry your weight; and 5) always, always, always tell those you love that you love them before you get off the phone or leave them.

In closing, I admit we are experiencing trying times, with issues that will not change as quickly as the leaves turn red and fall to the ground. But if we can collectively stand together, and practice kindness, civility, acceptance, honesty, humility, and respect for each other, we can all be heroes. For those wanting to go the extra mile by joining the Government Relations or Clinical Committees, contributing to our PAC, or even willing to be called on to provide your clinical expertise at the state or chapter level can contact me at dshoemaker@pamedsoc.org.

Luke D. Piper, MD PGY-3, Penn State Health Department of Psychiatry

A particularly remarkable transition that we have seen with the arrival of COVID-19 is an expeditious increase in the usage and availability of telepsychiatry. As a field, I think we have long theorized the potential benefits (and challenges) of this modality, but for several reasons, its implementation – at least on a large scale – has not gained much traction. That is, until a global pandemic forced us into action. I have written previously on how I view this as a good thing, and not simply for preserving the safety of providers and residents (though this is certainly a worthy ideal). I think it is a good thing that training residents have had a more involved opportunity to work with telepsychiatry as a mode of communication. Perhaps in the end, it isn’t a significant hurdle compared to our clinical practice as usual, but I suspect a lot of residents would affirm some initial growing pains in communicating with a computer monitor, or in some cases, a disembodied voice.

But I am thankful for the opportunity, and I suspect that it will work to the benefit of residents in years to come. With Pennsylvania’s state of emergency extended yet again, and the virus showing no indication of departing, it seems likely that telepsychiatry will remain an ideal method of care delivery for at least the next several months. But what comes after? One concern I have heard going around is that it may prove more difficult to halt telepsychiatry services than it was to engage them in the first place. Indeed, for many of my patients, particularly those who are on more simple regimens and whose concerns have been nicely stabilized, telepsychiatry has been not simply acceptable, but palatable.

This leads me to ponder a couple thoughts. One: if insurance companies elect not to pay for telepsychiatry after the state of emergency passes, how will our patients respond? Two, and perhaps more thought provoking: would it be in the interest of the state and insurance companies to sustain this momentum and carry telepsychiatry past the pandemic and into an expanded role in our delivery of mental health care? I will hasten to note that I recognize some notable weaknesses of telepsychiatry, including its reliance on technical literacy, stable internet connections, and intact power grids, as well as the reduced ability of a clinician to comprehensively assess a patient’s presentation. But for many patients, telepsychiatry may represent our best chance of enhancing appointment compliance, or of being able to deliver care to them in the first place. We’ve also seen it already gaining steam for its applications in integrated or collaborative care models, and I am cautiously optimistic that it will see an expanded role in this respect, ideally allowing our limited supply of psychiatrists to provide as much support as possible to primary care settings. I further wonder if this may allow for more residency programs to expose their trainees to collaborative care in the first place.

The year thus far has been anything but routine, but with great challenge comes great opportunity. I will be very interested to see if the vital role of telepsychiatry during this pandemic gives it the escape velocity needed to enter a more stable orbit around the globe of mental health care.