7:45 A.M. At the office, check out my staff's weekends; get coffee and turn to e-mail, looking for a colleague's response to a manuscript I sent over the weekend on assessing psychotherapy competencies. Nothing yet. Scads of e-mail messages waiting. East coast friends two hours ahead are cluttering cyberspace.
8:00 A.M. Mrs. A, whom I see privately through our practice plan, suffers from recurrent depression and binge eating disorder. Her maximal dose of venlafaxine provides only partial relief. A week ago she sustained a crisis concerning her job. We discuss it—she emotes and grieves. I help her to reframe issues and engage in creative problem solving. We also discuss options for medication augmentation and pick one.
8:45 A.M. Department executive committee meeting. Our task is to evaluate proposed faculty performance criteria for clinical activities stimulated by the health sciences center chief executive officer. To parallel this development, we opt to create better performance criteria for education and research-scholarship. Several of us take this challenge as homework. We'll draft something during the next month.
11:00 A.M. Meet with a potential new professor. He's on faculty elsewhere, but his activities dovetail nicely with our department's needs. I learn more about his personal situation and what's motivating his visit; catch up on politics in his current department; and encourage him to carefully consider opportunities with us.
11:45 A.M. After a desk lunch, I join a conference call of the American Psychiatric Association's Steering Committee on Practice Guidelines. Colleagues from all around the country. We discuss the nature of evidence-tables for literature reviews on which to base future practice guidelines. Revisions of guidelines for substance abuse and schizophrenia are on the drawing board.
Monday afternoon. Teaching clinic at the University Mental Health Center. Five postgraduate year 2 residents and two medical students see patients, supervised by the clinic director, a chief resident, and me.
1:00 P.M. — 2:00 P.M. I staff new patient evaluations, dividing my time between two residents' intakes: One sees a 50-year-old single, former construction worker, with combat related posttraumatic stress disorder and substance abuse. He had been clean and sober for 5 years but recently sustained major work-related injuries resulting in physical disability and clinical depression. The resident and I develop a treatment plan combining psychosocial interventions, brief therapy strategies, and medications. The second sees a 45-year-old former health professional, coping for years with a dysfunctional family of origin, who developed systemic lupus erythematosus and a pituitary adenoma. Treated with high dose steroids, she became morbidly obese, hypoxic, depressed, and totally incapacitated. We plan to phone her primary care physician and carefully review her physiological status and medications with him before making pharmacological interventions. The patient will also need to talk with the resident about her plight.
2:00 P.M. — 4:00 P.M. Staffing one-half hour follow-up appointments; seeing patients with bipolar disorder, major depression, panic disorder, and obsessive-compulsive disorder. I hear the residents' updates, discuss strategies for ongoing care, briefly interview each patient with the trainees, and write brief notes.
4:00 P.M. — 5:30 P.M. Monday clinic teaching conference, a most enjoyable activity, focused around my interviewing a difficult, confusing, interesting, and challenging patient presented by a resident or student. We begin with "culture rounds"—a concept shamelessly borrowed from my good friend, Dr. Michael Gitlin, who's conducted culture rounds at the University of California Los Angeles (UCLA) for decades. Trainees briefly present and critique movies, plays, concerts, home videos, outdoor activities, new restaurants, and other weekend activities. Although Culture Rounds take no more than 5-10 minutes, they affirm the importance of life outside the work environment.
Today's teaching conference patient fails to materialize, an infrequent occurrence. The resident, perplexed by the patient's story and having spent considerable time preparing the case, presents her in absentia. We hear of a 30-year-old woman suffering from what sounds like bipolar type I or bipolar type II disorder, severe childhood physical, emotional, and probably sexual abuse, who has just fled from an abusive marriage in another state, leaving her children in the custody of her problematic husband. Carefully picking the resident's brain for additional factoids based on available information, we hypothesize a tentative diagnosis of bipolar disorder type 1.5 disorder (someplace between type I and type II); do our best to think through further assessment and potential management issues; and acknowledge that all of our great, purely speculative ideas are subject to change completely once we interview this patient in person. Other residents briefly describe their new intakes and treatment decisions for the benefit of their colleagues.
5:30 P.M. Back in my office for paperwork. First, I chair the school's Graduate Medical Education Internal Review Committee, overseeing administratively mandated quality control reviews of all University of New Mexico School of Medicine postgraduate programs and, along with the graduate medical education staff, conduct many of them myself. This interesting role teaches me much about housestaff training and the doings in other departments, permitting me to meet huge numbers of faculty whom I might otherwise never encounter. A wonderful networking opportunity for psychiatry. Today I review the draft report of last week's family practice program site visit. Their brand new training director and program coordinator appreciated opportunities to discuss their challenges and pick our brains for suggestions to improve their operations.
Final paperwork of the day. For a young colleague elsewhere, I write a supporting letter to the National Institute of Mental Health for a K-23 Mentored Career Development Award. This award will support her continued eating disorders research. She's bright, talented, and hardworking, and has prepared a thoroughly impressive scholarly and creative proposal. I'm deeply warmed to know that exciting, inspired, young psychiatric investigators are preparing themselves to continue in the important work of careful clinical research. I think about inviting her out to do grand rounds.
6:30 P.M. Glance at tomorrow's calendar. An early research meeting concerning our National Institute of Mental Health study on impacts of providing psychiatric patients living in rural areas with computers and Internet access. One last peek at e-mail. Scores of messages, a handful of which might actually be important. My colleague has returned the draft with detailed comments. I'll get to that later on. For now, time to go home.
What do I find academically fulfilling? A variety of tasks? The multiple stimulations of teaching, research, and scholarship? A wonderful network of colleagues and friends (locally, nationally and internationally)? Feeling that my efforts may, in some small ways, positively impact students, peers, patients, families, systems, and the larger profession? Yes.