C&L Resources

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sunlioness

sunlioness

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So in my new job I am the permanent back-up for the C&L guy. Now, I am not a huge fan of C&L, but I would like to become one. I honestly think the reason I probably don't like it has more to do with it being something I don't feel familiar enough with or adequately enough trained in. Most things, I do okay with (assessing need for sitters, assessing lethality, run of the mill evals that aren't that much different than what I do anyway), but then I get a call about some delirious intubated brain injured person in the ICU who gets combative when they try to wean the propofol and I get all fluttery. :scared: And capacity. *shudder*

So I need a crash course. A pocket-sized psychosomatic medicine fellowship. What resources do you recommend? I am up for hearing about books I should read. I am up for hearing about good go-to resources I should have accessible. I am up for hearing about conferences I should go to. Lay them on me. Please. Especially any good resources on delirium in various settings, etc.

Thank you!

SL
 
sunlioness said:
So in my new job I am the permanent back-up for the C&L guy. Now, I am not a huge fan of C&L, but I would like to become one. I honestly think the reason I probably don't like it has more to do with it being something I don't feel familiar enough with or adequately enough trained in. Most things, I do okay with (assessing need for sitters, assessing lethality, run of the mill evals that aren't that much different than what I do anyway), but then I get a call about some delirious intubated brain injured person in the ICU who gets combative when they try to wean the propofol and I get all fluttery. :scared: And capacity. *shudder*

So I need a crash course. A pocket-sized psychosomatic medicine fellowship. What resources do you recommend? I am up for hearing about books I should read. I am up for hearing about good go-to resources I should have accessible. I am up for hearing about conferences I should go to. Lay them on me. Please. Especially any good resources on delirium in various settings, etc.

Thank you!

SL
Click to expand...

I am a medical student currently applying to psych. Just wondering how you felt about your C.L. training during your residency (I am assuming you did not do a C.L. fellowship). I am asking because Yale is one of the programs that I really like, but it is perceived to be weak in C.L. This could be a real problem since residents spend a lot of time doing consults while on call.
 
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Nope, I haven't done a psychosomatic medicine fellowship. Though I was looking a few up online last night out of curiosity. This is the thing about my residency training . . . I don't think I properly took advantage of the C&L training that was available to me. At the time, and I regret this, my motivation was one of "let's just get through this most disliked rotation". With the benefit of hindsight, I'd approach it much differently now. Another factor, is that while many 4th year residents have the benefit of re-visiting things like C&L as a PGY-4 to get more advanced trained as a senior resident, I couldn't do that either because I had switched into psychiatry from IM as a PGY-2 and that ate up all my elective time.

Anyway, the moral of my story is that when you encounter things that are scary difficult in residency, it's best to jump right in until they're not scary-difficult anymore. Because they're not going to get any less scary-difficult if you don't and it's harder (though not impossible) to get appropriate support/guidance when you're the attending who's ultimately responsible for things.
 
sunlioness said:
"let's just get through this most disliked rotation".
Click to expand...

HAH! Ahhhhhh the 12 hour shifts, constant beeping pager, running around the hospital and filling one's pockets with snacks and energy bars. Definitely physically exhausting over time. Right now I'm emotionally exhausted with all the back to back therapy sessions and time passing by at a glacial pace. I don't know which poison is better... 😛 I kinda wish my program had a CL fellowship- I find it quite fascinating but it's not moving-out-of-state fascinating...tired of moving all the freaking time.
 
F0nzie said:
HAH! Ahhhhhh the 12 hour shifts, constant beeping pager, running around the hospital and filling one's pockets with snacks and energy bars. Definitely physically exhausting over time. Right now I'm emotionally exhausted with all the back to back therapy sessions and time passing by at a glacial pace. I don't know which poison is better... 😛 I kinda wish my program had a CL fellowship- I find it quite fascinating but it's not moving-out-of-state fascinating...tired of moving all the freaking time.
Click to expand...

Yes, the pager! And dealing with all sorts of angry people wherever you go (you know, the primary team, the nurses, the SW, the patient's family). This is what I don't like about CL. But yeah, it's also the rotation that reminds me of how much stuff I don't know and need to learn.
 
Doctor Bagel said:
Yes, the pager! And dealing with all sorts of angry people wherever you go (you know, the primary team, the nurses, the SW, the patient's family). This is what I don't like about CL. But yeah, it's also the rotation that reminds me of how much stuff I don't know and need to learn.
Click to expand...

Be the wall, "nah nah nah nah nah nah" [chevy chase impression]
 
Just out of curiosity . . . are we the only specialty that's created an entire subspecialty out of doing consults? I can't think of any others. I think that's pretty cool actually.
 
The MGH Handbook (already mentioned) is the Bible of the field. Levenson is an excellent reference, but typically too dense for casual reading. Capacity consults should be very straightforward - this is a nice, readable book that sums it all up nicely:

http://www.amazon.com/Evaluation-Ca...1?s=books&ie=UTF8&qid=1325201984&sr=1-1-spell

Defining Psychosomatic Medicine as a field is perhaps a little more complex than "doing consults." Subspecialty recognition requires the establishment of a specialized knowledge base - in this case, psychiatric care of the medically ill, medical illnesses that present with psychiatric symptoms, psychiatric evaluation for medical procedures (capacity, transplant, bariatric surgery), etc.
 
has anyone ever heard of a family medicine resident getting into a psychosomatic fellowship..or is it totally unheard of and not even possible?
 
markglt said:
has anyone ever heard of a family medicine resident getting into a psychosomatic fellowship..or is it totally unheard of and not even possible?
Click to expand...

Psychosomatics is a psychiatric subspecialty. While I recognize the overlap with FP and psych, it's a different beast. So no, I do not believe it's possible.
 
sunlioness said:
Anyway, the moral of my story is that when you encounter things that are scary difficult in residency, it's best to jump right in until they're not scary-difficult anymore. Because they're not going to get any less scary-difficult if you don't and it's harder (though not impossible) to get appropriate support/guidance when you're the attending who's ultimately responsible for things.
Click to expand...
Just wanted to point out that this is really good advice. 👍 I think in residency there is often a desire to appear competent and confident that can get in the way of this, but you're so right that it doesn't get any easier.
 
markglt said:
has anyone ever heard of a family medicine resident getting into a psychosomatic fellowship..or is it totally unheard of and not even possible?
Click to expand...

You may already know this, but just in case you don't: Family Med residents can get credit for 1 year of training in psych so you only have to do three years of the psych residency if you switch. If you seriously think that you're interested in psychosomatic med, depending on how far along you are in residency it may not be a bad idea to consider switching to join us on the psych side. 🙂
 
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