Inpatient docs (physicians)... are you leading groups on the unit?

[fiatslug]

---

Members don't see this ad.

I work on a child & adolescent unit and I'm really advocating for the docs to run groups. The Powers that Be apparently don't want us doing that, but I have to think groups are a sustainable billing model as well, right? Anyone doing it?

 

[notdeadyet]

Why not have therapists/psychologists do this? Where is the value add of a psychiatrist?


Sent from my iPhone using Tapatalk

 

[fiatslug]

We want to, we enjoy it, using our skill sets, offering things psychologists and therapists can't...

 

[smalltownpsych]

Yalom is a psychiatrist that literally wrote the book on inpatient group psychotherapy. All the inpatient settings that I have been, the psychiatrists don't run any groups and tend to not be very involved in the milieu. When psychologists are there, especially myself since group and milieu therapy tend to be interests of mine, we tend to take those roles. From an administrative point of view, it is hard to find enough psychiatrists to manage the meds for their patients, so they want you to stick to that.

 

[nitemagi]

I have seen groups run by psychiatrists on med education, as well as QA time in general. I have run outpatient groups before, and even set up a DBT-lite at the VA. It's not common, but that doesn't mean it's a bad idea.

1. Do the psychiatrists want to do it?
2. Do they have the skills to do it?
3. Can the admin be convinced that it's (a) profitable and (b) useful?

 

[Shikima]

I have seen groups run by psychiatrists on med education, as well as QA time in general. I have run outpatient groups before, and even set up a DBT-lite at the VA. It's not common, but that doesn't mean it's a bad idea.

1. Do the psychiatrists want to do it?
2. Do they have the skills to do it?
3. Can the admin be convinced that it's (a) profitable and (b) useful?

You've pretty much hit the nail on the head there. Everyone is pigeon-holed into a job pretty much for the biggest bang for the buck.

 

[cookymonster]

Bottom line, learning the skills of conducting group therapy isn't emphasized in our training. As a resident, I hardly ever even conducted family meetings, and learning how to manage a room fraught with emotions and pathology among 3-4 people is difficult enough.

Working on an inpatient unit, I'd love to be able to observe the social behavior of my patients in groups (rather than just rely on the reports of social workers) and provide them with that feedback in my daily meetings and individual therapy with them. But as far as leading and managing groups of 10-20 patients, most of whose meds and discharge plans I don't primarily manage, whose principal diagnoses range from schizophrenia to antisocial personality disorder? No thanks.

 

[notdeadyet]

We want to, we enjoy it, using our skill sets, offering things psychologists and therapists can't...

I get the first three but not the last. I'm not sure my training has significantly more value add to justify the cost of a psychiatrist over a psychologist doing this. Though I do get the first three.


Sent from my iPhone using Tapatalk

 

[splik]

I absolutely love running groups and wish I had more experience doing so. At our VA the inpatient groups were primarily run by MDs though the SWs also ran some groups. I do think psychoeducation groups which include education about different medications are best run by psychiatrists. I ran an existential psychotherapy group on an inpatient VA unit and the patients loved it, seemed to benefit from it, it was the most popular group on the unit (they didn't like the CBT-lite or educationy groups). am on my child rotation now and I do run a group with a psychology intern which again is great fun, in fact I am probably enjoying myself too much for it to feel like work.

Although I have some sympathy with the cost-effectiveness arguments, it is a slipperly slope. Psychiatrists on inpatient units are generally seen as only good for diagnoses, pushing pills, and risk assessment. It is a sad state of affairs when psychiatrists have allowed their skills to be devalued and marginalized to limiting tasks. Why should we let the social workers and psychologists have the fun? As psychiatrists are supposed to be the leaders of the multidisciplinary team they should have a good understanding of and involvement in a range of different roles rather than being relegated to being the "prescriber". If we are to break out of this devaluing I think it is important to get involved in a range of different activities including running groups. This is an important lesson for staff too, who may not realize that we can actually provide these sorts of services or that we even want to.

 

[splik]

also i know child psychiatrists who run multi-family therapy groups

 

[hamlake]

I ran an existential psychotherapy group on an inpatient VA unit and the patients loved it, seemed to benefit from it, it was the most popular group on the unit (they didn't like the CBT-lite or educationy groups).

I ran an outpatient group during training and read Yalom's Existential Psychotherapy a year or two ago, but have never done existential psychotherapy in the group setting. I will be in charge of a small inpatient unit soon, and I'd like to conduct group psychotherapy if possible. My experience is also that many patients don't like or benefit from "CBT-lite" or "educationy" inpatient groups, though some certainly do, especially if done well. Any recommendations for texts on existential psychotherapy, particularly in the group setting, in addition to Yalom?

 

[splik]

yalom's theory and practice of group psychotherapy is the definitive text and definitely has an existential bent (unsurprisingly)

 

[whopper]

I don't but I'm only on the unit 4 hours a day when I do inpatient. SLU's inpatient attendings rotate there for only a few weeks at a time and we have other afternoon responsibilities. In order to give top-notch teaching, I spend the full-time working with residents and medstudents and don't do groups.

But, while I was in the state hospital, I literally had nothing to do for several hours a day so I volunteered to do groups. It helps in some ways. E.g. you can see how patients process information outside of an interview setting. The people running the group could also entertain questions they could likely not answer and refer to you.