After 25 years as an academic consultation-liaison psychiatrist, my professional life changed dramatically in 1994 when I was selected to lead a new multidisciplinary women's health initiative at the University of Toronto's largest teaching hospital.
A typical day starts with a patient at 8 AM, and today I see a 34-year-old woman with bipolar affective disorder who has recently discovered that she is 8 weeks pregnant. Her attending psychiatrist is concerned about continuing to prescribe lithium and has referred her for consultation. Based on her past unstable illness history, I recommend that lithium be continued throughout the pregnancy and that she undergo a level 2 ultrasound in the second trimester to rule out congenital anomalies. I recommend that her lithium dose be carefully monitored during pregnancy to avoid suboptimal levels and after delivery to prevent toxicity. I advise the patient of the risk of postpartum bipolar relapse and encourage follow-up with her psychiatrist. I conclude by writing a consultation letter to her psychiatrist, and with the patient's permission, copy her obstetrician.
At 9, I meet briefly with my administrative assistant to discuss the day's events and sign various forms, requisitions, and payment authorizations.
At 9:30, I grab my slides and PowerPoint disk and head off to the department of surgery in another hospital where I give a 90-minute interactive presentation to residents on boundary issues in practice.
At 11, I return to my office and begin reading the myriad e-mails that flood in each day. Although e-mails are wonderful for timely communication, they also waste an enormous amount of time.
This is followed at 11:30 by a research group meeting to discuss the contents of the final report on the health status of Ontario women. This project, funded by the ministry of health, required a multiskilled team of investigators to perform data analyses and draw conclusions. As the project nears completion we tidy up loose ends and develop final policy recommendations.
The meeting concludes at 12:30, and I head downstairs to pick up a salad to eat in front of my computer. I see 30 more e-mails have sifted in since 11 o'clock, including a plea to sequester a small fortune by a huckster purporting to be a prince from a third world country. Rather than providing my bank account number as requested, I instead forward the message to the local fraud squad!
At 1 o'clock I meet with a medical student who has elected to do his Determinants of Health in the Community project on how men and women from different cultures perceive abusive marital relationships. The student, who plans to enter psychiatry residency, has done a fine job on the methodology of his project but needs help in formulating the ethics proposal.
At 2, I scan my snail mail and notice some galley proofs for a journal article that has been accepted for publication and another manuscript that requires some revisions and resubmission. I scan the galley proofs, arrange for them to be couriered back to the publisher, and begin the necessary revisions to the second paper. Early in this process however I receive a phone call from our hospital lawyer about the negotiation of a contract with Health Canada to develop a national women's health status report (similar to the one we are completing for Ontario). The lawyer and I laugh about the proposed government contract which looks more appropriate for building a road then producing a health report. We discuss how best to protect academic freedom, publication rights, and intellectual property and agree to touch base later. I take a phone call from an evening news reporter who wants to discuss "a hot medical breakthrough." A brief call to the Public Health Department finalizes the agenda for a meeting scheduled later this week.
It's already 3 o'clock and time for a follow-up visit by an elderly depressed woman who started an antidepressant three weeks ago. She is beginning to feel better but remains fearful that the depression will recur. I reassure her and arrange to see her again in 2 weeks.
At 3:30, I join a conference call with colleagues who are submitting a multi-site grant on barriers and incentives to enrolling women in cardiac rehabilitation and the effect of an intervention on referral rates. Today we finalize our strategy and agree on tasks.
At 4 o'clock, I attend the Medical Advisory Board with other departmental chairs and hospital administration. Today's meeting is rather lengthy as the hospital is preparing for accreditation and some outstanding administrative issues need resolution. At 5:30, I return to my office and spend the next hour finishing e-mails, writing letters, signing authorizations, and deciding what work materials to take home that evening. (Certainly those unfinished journal revisions!)
At 6:30 my husband picks me up, and we head home for supper. I usually work in the evening from eight to ten, writing or reviewing manuscripts or grants, and catching up on the many things that don't fit into "working hours." In late evening my husband and I enjoy a cup of tea, discuss the events of the next day, and head off to bed.
What I have described is a pretty representative day in my calendar when I am in Toronto. My position also requires a lot of national and international travel for meetings, presentations, and consultations which are not represented here. I note with surprise that today has not included any off-site, university, or government meetings. I love the variety of my work: an array of patient care, education, research, administration, policy and leadership. The daily interaction with patients, students, residents, fellows, post docs, colleagues from other specialties and disciplines, hospital administration, government and international policy makers and advocacy groups, gives me a stimulating breadth of experience and feeling that I'm making a difference. It is very different from my life before 1994, but I wouldn't trade it for the world!