The Psychiatric Hospitalist. A Career Guide

August 2022

BOOK REVIEWS: The Psychiatric Hospitalist. A Career Guide

Aug
2022
Vol. 34. No. 3
Richard Balon, MD

Departments of Psychiatry and Behavioral Neurosciences and Anesthesiology
Wayne State University School of Medicine
Detroit, Michigan, USA

The traditional model of private practice in which the physician rounded and took care of their hospitalized patients during the morning and then went to see patients in their private office or clinic has been gradually changing. Some physicians see patients only in their offices or clinics and, if needed, refer them to inpatient care of physicians who practice solely in hospital inpatient units, so-called hospitalists. Regardless of the reason for this change, I am not sure if this split of practicing medicine is beneficial to patients. Patient care is becoming compartmentalized, and continuity of care frequently is lost. Psychiatry has joined other specialties and we are starting to see more practicing psychiatric hospitalists. However, as the editor of this volume, Dr. Michael Jibson, writes “Hospitalist psychiatry as a career choice alongside other ‘intensivist’ specialties is still struggling to be given serious consideration” (p ix).

Being an enthusiastic psychiatric hospitalist, Dr. Jibson put together a group of authors (mostly from his department at the University of Michigan) and created this volume, which was conceptualized for the newcomers to the field of psychiatric hospitalist to help them to launch “a career in hospital-based psychiatry” (p x).

The book consists of 4 parts: I. Framework; II. Skill Set; III. Clinical Care; and IV. Special Issues. The 3 chapters in Part I address the hospitalist model in psychiatry; inpatient service; and consultation-liaison (C/L) psychiatry. The discussion of the hospitalist model reviews the structure of the hospitalist service and the advantages (eg, consistency, efficiency, expertise) and challenges (eg, discontinuity in treatment, short-term perspective) of the hospitalist model. This chapter reveals an issue inherent to this book: Who is the intended audience? First, the author writes that “instead of having academic faculty rotate on hospital services for a month or two during the year or having private practice physicians see patients in the office during one part of the day and then travel to the hospital to complete rounds on patients there…” (p 4) hospitals should move toward having dedicated hospitalists. The reference to academic medical centers and their way of rotating physicians is not something that happens in all academic centers and not something that usually happens in nonacademic hospitals. I was also surprised by the use of the term “provider” here; it should be avoided, as it was used by Nazis to label Jewish physicians. The following 2 chapters describe the inpatient and C/L psychiatric services, providing some useful advice, eg, to avoid service-specific abbreviations, or, in the case of the C/L service, getting the question right, because “‘inappropriate’ consult questions are one of the most frustrating aspects of work as a C-L psychiatrist” (p 35).

The second part of the book focuses on building one’s skill set to be a hospitalist, discussing training and background; career development in the hospital setting; leadership and administration; and teaching and supervision. The question of intended audience again comes to mind. The chapter on training and background discusses “the aspects of general medical education, internship and residency, and fellowship training that an interested student or resident will find useful…” (p 43). The author describes in detail all fellowships, including those in related fields, eg, brain injury medicine; hospice and palliative care; and sleep medicine. The otherwise useful chapter on career development includes a discussion of promotion, academic rank, tenure vs clinical tracks, and hospital-based activities leading to promotion. The chapter on leadership and administration focuses on issues such as work with interdisciplinary teams; regulatory systems and legal issues; finances, billing, and budget; and quality improvement and staff wellness. The last chapter of this part deals with issues specific to teaching hospitals—teaching, ways and methods of supervision, dealing with different learners, and using residents as ‘junior attendings.”

The third part of this book covers initial assessment and treatment planning; diagnostic and treatment modalities; guidelines, algorithms, and order sets; acute disorders; transition in care, documentation, and interdisciplinary communication; and discharge and transition to outpatient care. I expected a bit more in-depth coverage of areas such as initial evaluation and diagnostic modalities, and a bit more critical evaluation of guidelines and algorithms. The chapters on transition of care and on discharge are solid and useful, though I would like to have seen a discussion of when to discharge to outpatient services vs day hospital.

The last part of this volume deals with legal and ethical issues; quality assessment and improvement; patient safety; and adverse events. These chapters are useful and relevant to everyday clinical practice, especially the ones on legal issues and on adverse events (this chapter includes an important discussion of morbidity and mortality conferences).

I was clearly left with mixed feelings about this volume, even when putting aside the issues of fragmentation and compartmentalization of care. There is a considerable amount of overlap among chapters. Some chapters are useful (including good vignettes), while others are superficial. The focus on academic center psychiatry, or rather the lack of a discussion of hospital-based psychiatry in most hospitals in this country, is unfortunate. I also missed a discussion of special settings, such as Veteran Administration hospitals, state hospitals, or special child and adolescent hospitals or units. The discussion of special psychiatric emergency rooms that some hospitals have would also be useful. This book is a well-intended introduction to the field of hospitalist psychiatry that some novices may find useful, while those outside of academic centers may be looking for more.

CORRESPONDENCE

Richard Balon, MD
Detroit, Michigan, USA