In 2002, I celebrated 25 years of working in the University of California, San Francisco (UCSF) Department of Psychiatry at San Francisco General Hospital (SFGH). I have an Academic Senate appointment as professor of clinical psychiatry, and I am the senior ethnic minority psychiatrist in our UCSF department. Sometimes, people ask why I have stayed at SFGH for so long a period of time. What has sustained me through the years has been the opportunity (as illustrated in my "Day in the Life" brief) to participate in the development of cultural competence and local and national diversity, residency training activities, and public sector psychiatry.
At 8:00 A.M. I join a 1-hour conference call of the planning committee for the March 2003 Annual Meeting of the American College of Mental Health Administration (ACMHA). The theme this year focuses on "Reducing Disparities in Mental Health." It builds on the 2001 Surgeon General Report on Mental Health: Culture, Race and Ethnicity and the 2002 Institute of Medicine Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. I enjoy the joint effort to develop a national meeting that will help implement recommendations from these reports.
At 9:00 A.M. I meet with Ken Gee, M.D., Associate Clinical Professor of Psychiatry and the Unit Chief of the Asian Focus Inpatient Unit at SFGH. I am his career mentor, a role I have served for the past 15 years, stretching back to his residency years at UCSF. We discuss the implementation of a recently funded Federal Center for Mental Health Services (CMHS) training grant on Asian American mental health issues. Led by the National Asian American Pacific Islander Mental Health Association, the five-site multidisciplinary grant has the Asian Focus Inpatient Unit as the one psychiatry site where we focus on Post Graduate Year (PGY)-I resident training as we have done since 1980. The joy of helping develop the next generation of trainees, as well as leaders such as Ken Gee, has been very meaningful to me over the years.
At 10:00 A.M. I drive from SFGH to Langley Porter Psychiatric Institute at the main UCSF campus. Meanwhile, I check voicemail on my cell phone and return calls.
From 10:30 A.M. to noon, I participate in the weekly Residency Selection Committee (late October-early February), of which I have been a member for 18 years. We review candidates interviewed the previous week and decide on recruitment strategies. I agree to contact two ethnic minority candidates that I had interviewed to invite them back for second visits. As with my meeting with Ken Gee, this activity has been very rewarding for me as a way to recruit residents who may become future junior faculty members. This is a way that cultural diversity of residents and faculty can be developed over time.
At noon, I have a lunch mentorship meeting with Naomi Lam, M.D., who just became a Clinical Instructor on our volunteer faculty after graduating in June 2002. I have served as her career mentor since 1998, her first year at the UCSF residency program. I had helped recruit her into our program. She just began working at two agencies that care for the seriously and persistently mentally ill in San Francisco. We talk about the adjustment to her new roles, the joys and frustrations of public psychiatry, and teaching activities at UCSF. We consider the possibility of her being an off-unit supervisor for a PGY-I resident who is rotating on the inpatient units at SFGH. I remember that when she was a PGY-I resident, I had supervised her in that role, as well as having supervised a PGY-4 elective resident, Jacquelyn Chang, M.D., who was an off-unit supervisor for her as well.
I am struck by how quickly time passes as residents become supervisors, while at the same time marveling at the miraculous beauty of such transformation—the will to teach is truly a calling which can inspire others to do the same!
Between 1:00 P.M. and 3:00 P.M., I meet with the UCSF Academic Senate Committee on Equal Opportunity. This monthly meeting focuses on ways to increase faculty diversity at the four schools of UCSF (medicine, nursing, dentistry, and pharmacy). We grapple with ways of assessing the effectiveness of faculty search committees in recruiting and selecting diverse faculty members. This exemplifies how my initial cultural diversity work in the department of psychiatry has provided me the basis for work at higher levels of the overall organization.
I drive back to SFGH, arriving at 3:30 P.M. for a 1-hour meeting with Sareena Singh, M.D., one of the PGY-I residents at SFGH, for our weekly off-unit supervision. We discuss her current caseload, which includes a man who experienced torture in Iran before coming to San Francisco. I offer a book on this topic from my library, which she greatly appreciates.
From 4:30 P.M. to 5:30 P.M., I meet with Kim Indermaur, M.D., another PGY-I resident, who will be presenting one of her patients at the department case conference in about 2 weeks. Each of the eight residents will present one case during their 6 months at SFGH. I review their DSM-IV Outline for Cultural Formulation so these cultural issues are routinely covered consistent with the Residency Review Committee (RRC) special requirements about "integrative case formulation." I have found this case-based method of teaching very effective in engaging residents around cultural issues.
After reviewing e-mail, voicemail, and regular mail, I pick up some take-out food from the Vietnamese restaurant across from the hospital and drive to a 7:00 P.M. potluck dinner meeting of the Northern California Psychiatric Society Committee on Asian American Issues. This American Psychiatric Association (APA) District Branch Committee, co-chaired by Jacquelyn Chang, M.D. (Assistant Clinical Professor on the volunteer faculty) and myself, meets quarterly to serve as a support group for those psychiatrists interested in Asian American issues. Al Gaw, M.D., a Clinical Professor of psychiatry at UCSF, presented a case, which he was treating, of a severe eating disorder in a Thai woman that began 30 years ago. As he described the patient, I remembered working with her when I was the Unit Chief of the Asian Focus Unit at SFGH in the early 1980s.
In 1978, I attended a 5-day seminar on "Hinduism and Buddhism in Oriental Art," given by Joseph Campbell at Esalen Institute in Big Sur, California. I had just returned to San Francisco after growing up on the east coast. At the end of the seminar, I experienced an epiphany that my purpose in life was to bring together the East and the West. Little did I to know that after those 25 years, I would be experiencing a day as I just described. I am grateful to have had the opportunity to teach residents, mentor junior and mid-level faculty, and participate in administrative and educational initiatives that will continue to develop cultural competence and diversity over the years.