PENNSYLVANIA
JULY 2020
P S YC H I AT R I S T NEWSLETTER OF THE PENNSYLVANIA PSYCHIATRIC SOCIETY
PRESIDENT’S MESSAGE
By Richard R. Silbert, MD, DLFAPA PaPS President
I am honored to serve, over the next 12 months, as your president for the Pennsylvania Psychiatric Society, PaPS. However, I never could have imagined this would come at such a stressful time for us, our families, our colleagues and most importantly – our patients. Civil protests over the tragic murder of George Floyd and the pandemic have almost wiped off our radar prior vital concerns that include the opioid epidemic and the tragic rise in completed suicides. I do not doubt that, even more, our professional duties and services will be needed to respond to the increased fears and traumatic responses. Misinformation, miseducation and finding ourselves isolated, seems sadly the norm these days. Seemingly buried under an avalanche of crises, we will need as a Society to continue to attend to what only last year were significant challenges: • S ince I’m part of the large number of psychiatrists either greying or aging, I’m acutely aware we need not only good people with good minds to choose to enter psychiatric residencies, but we must support and facilitate Early Career Psychiatrists’ development to become leaders and educators. •W e must continue to realign our activities in such a manner that our expenses no longer exceed our revenues. And at least a neutral budget will allow us to be good, to do good. Ironically, the pandemic precautions offered us familiarity with less expensive ways to provide meetings for education and advocacy. •W e need to monitor that the yeoman’s work done by Dr. Edelsohn and the professional staff on Maintenance of Certification goes forward. The pandemic precautions add to barriers towards completing what many members saw as questionable and expensive requirements. •O ur committees would welcome and benefit from your participation. Please reach out to your PaPS staff as well as to any one on the executive council to get involved. I remain in awe of how Drs. Certa, Feinberg, Albaugh, Dougherty, Stowell and past PaPS presidents helped Deb Shoemaker and Dawn Losiewicz respond to legislation and government relations, but they need ongoing support and eventual successors. Though it may be a stay at home effort (as of this writing, my county is still red status), I still hope to further our ongoing Society objectives, that is to Engage, Educate, and Advocate. As soon as it’s deemed safe to do so, I hope to travel to and meet local chapter leadership but meanwhile as we’ve become more of a virtual world in our profession, I would welcome calls, emails (silbertrr@upmc.edu or silbertrr@ccbh.com) and internet chats. I sincerely hope you can have an enjoyable summer to mitigate the trying year we have all had.
Richard
TABLE OF CONTENTS 2 | Banding Together for COVID 3 | Editor’s Column 4 | Activity Update 5 | Resident Update 6 | PAMED Everyday Heros 8 | Donate to Our PAC 9 | Telepsychiatry 10 | Committee Interest Form 11 | Meet the Executive Committee
Don’t miss what PaPS is working on for you! Check out the Activity Update.
Banding Together for COVID and Post-COVID Edwin Kim, MD Medical Director Physicians’ Health Program Before the global pandemic, physicians and trainees were facing the ongoing epidemic of burnout. In a post-COVID era, we are anticipating an exacerbation of medical workers’ well-being with the introduction of traumatic stress, anxiety, and depression. We would like to invite a group of experts in the realm of PTSD, physician burnout, and peer review to participate in a joint effort with the Pennsylvania Physician Health Program to produce postCOVID education and potential referral path to treatment. The goal is to connect Pennsylvania physicians and trainees to a well-qualified network of psychiatrists and mental health clinicians that can provide trauma-informed care to individuals impacted directly and indirectly by COVID-19. This service will supplement ongoing efforts by larger institutions (EAPs, wellness committees/offices, Human Resources) by addressing a significant potential obstacle to seeking care, particularly privacy. This also addresses access to care issues by connecting physicians in areas with less formalized support systems to a state-wide network. If you are interested in participating in this Post-COVID Task Force, please contact PaPS Staff by July 17, 2020.
#PennsylvaniaStrong
Stay connected with PaPS and follow us
@PA_PsychSociety on TWITTER!
2
P E N N S Y L V A N I A P S Y C H I A T R I S T | J U LY 2 0 2 0
EDITOR’S COLUMN How To Assassinate a Medical Specialty by Edward C. Leonard, Jr., MD, DLFAPA
The best thing that ever happened to Susannah Cahalan was having seizures when she was delusional and hallucinating ten years ago. That neurological sign encouraged her doctor to get a newly developed test that showed autoimmune encephalitis, which was treated successfully. Since publishing Brain on Fire, her memoir about this psychotic episode, Cahalan has made many presentations encouraging clinicians to search for causative medical conditions in all who present with mental symptoms. Ensuing discussions with mental health professionals introduced her to David Rosenhan’s 1973 article in Science, “On Being Sane in Insane Places,” which reported what happened to eight healthy women and men who essentially sought psychiatric hospital admission only for hearing voices saying “thud, empty, hollow.”
chart given him by the admitting psychiatrist who was troubled by the article’s lies. Cahalan is cautious in drawing conclusions, but the thrust of the evidence points to deliberate falsification of research in what now seems to be Rosenhan’s gleeful vilification of psychiatry. Seen as a hoax that continues to defame psychiatrists, this article may be the single worst thing that ever happened to our field. It was used by politicians to justify closing mental hospitals, by insurance companies to refuse treatment to suffering patients, by lawyers to challenge psychiatric diagnosis in court and commitment hearings, and it turned countless numbers of college students away from considering careers in our specialty. Everyone interested in how psychiatry got to where it is today must read Susannah Cahalan’s Great Pretender.
In her new book, The Great Pretender: The undercover mission that changed our understanding of madness, she suggests that Robert Spitzer felt that the attack on psychiatric diagnoses in Rosenhan’s article was the best encouragement his DSM project ever received. Cahalan notes that, by never publishing the additional symptoms Rosenhan reported to Haverford State Hospital, Spitzer protected his research from deserved disparagement. The medical record includes Rosenhan saying that the hallucinations were longstanding, troubled him enough to try putting a copper pot over his ears to dampen them, and resulted in suicidal ideas. In addition, not mentioned in “On Being Sane in Insane Places,” the admitting psychiatrist had asked two other psychiatrists to talk with Rosenhan to confirm his need for admission. Cahalan’s access to David Rosenhan’s files encouraged her to search for the other seven pseudo-patients in his study. She only found one. However, she did find a “ninth” pseudo-patient who was mentioned only in a footnote excluding him from the study because he reported more symptoms than a voice saying thud, empty, and hollow. She then found a draft of Rosenhan’s article, which included the ninth pseudo-patient. Comparison with a later draft with only eight pseudo-patients showed the published quantitative data was faked. Her book is a magnificent example of how a thorough reporter investigates her subject, but all psychiatrists should be grateful to Rosenhan’s son for gifting Cahalan permission to publish excerpts from the medical record that no psychiatrist could have quoted during Rosenhan’s life. Spitzer had an unauthorized copy of the
P E N N S Y L V A N I A P S Y C H I A T R I S T | J U LY 2 0 2 0
3
ACTIVITY UPDATE
by Deborah Shoemaker, Lobbyist
It Is the End of the World As We Know It…But Do We Feel Fine? I started to write this article a few weeks ago when the commonwealth was starting to re-open in phases. Yes, we had to speculate what Red, Yellow and Green meant, but at least we had hope for a phased opening, based on “the science and the medical communities’ recommendations”. Not all citizens, county commissioners, or even state legislators agreed with the criteria that Governor Wolf and Department of Health Secretary Rachel Levine, MD, created based on guidance from the Centers for Disease Control (CDC), the World Health Organization (WHO), medical researchers and epidemiologists or even Anthony Fauci, MD. Our governor took a strong stand to support the science, even providing limited liability protection to health care providers laboring in the trenches during this pandemic. Governor Wolf went further by cautioning rogue county commissioners and businesses who wanted to open early, cautioning against further outbreaks caused by prematurely opening hotspots across the state. Being a businessman, the governor understood the economic losses, the daily increases to the unemployment rolls, and the effects that a partial closure could do to children without in-person schooling, parents now taking over the “teacher role”, trying to put food on the table while staying at home collecting unemployment benefits. His decisions were not popular, but necessary. Both Governor Wolf and Secretary Levine have faced enormous criticism for following the science, even some leaders asking for their resignations and/or impeachment. Regardless of your political affiliation, or your thoughts on the pandemic and how it was handled in Pennsylvania and on the national level, following the science is not always popular but necessary. As a parent of a now-virtually graduated high school senior, I had mixed feelings when the COVID-19 pandemic began in earnest. My first reaction was pride in how your staff worked so closely with chapter leadership and our educational chairs in canceling/postponing/ rescheduling educational meetings – often at a moment’s notice. I know that some were last-minute, but the goal was to ensure the safety of our members, our staff, and our presenters. Everyone has been short of amazing in making decisions, then and now, that will maximize the member educational experience and ensure that they are not causing any undue harm or angst to those involved in providing this important member benefit. My second reaction was concern and angst about the pandemic- how personally it affected my son who now could not play his senior year of lacrosse or graduate with his friends; professionally, how I felt when I knew all of you were exposing yourselves daily to the pandemic – without the proper equipment, without the knowledge of knowing how long this pandemic will last, or if you are exposing your loved ones to future harm. My final reaction was hope in the process, knowing that we were going to roll with the punches and make things
4
P E N N S Y L V A N I A P S Y C H I A T R I S T | J U LY 2 0 2 0
work, regardless of the actions of the public who chose not to wear masks during the yellow phase, and to advocate for continued use of telemedicine, additional liability protections for all healthcare providers (regardless of the practice setting), and for increased funding for PPE equipment, for additional COVID-19 testing and for enhanced treatment and services for mental health and substance use treatment. However, all my hope and anticipation died on May 25th, when George Floyd lost his life at the hands of a police officer in Minneapolis. Whenever police are involved, my reaction is mixed: wanting all the facts before deciding. I am a police chief’s daughter. However, my father never tolerated profiling, racial injustice, unfairness, or prejudice, nor expected us to stand for it. If he were alive, he would be sickened and embarrassed of his fellow officers. I am incensed. No one should have to die that way, begging for their own life by saying “I can’t breathe” while ignored. I am not naïve to say I will ever understand how George Floyd felt his entire life. I am not a black man. I am a woman, one who has fought for everything in my life, but never at the level of George Floyd, or Martin Luther King or Nelson Mandela. Although we were not rich by any means, I never had to stand in a soup line, or beg for mercy for being charged just because of the color of my skin, or face bullying because of my gender preference. I have not yet been truly persecuted because of my religious choice, or because of my political affiliation, or my medical conditions. I try to do my part by joining worthy causes, feeding the homeless, even something as simple as voting or even protesting, but I feel it is not enough. As psychiatrists, you have dedicated your lives to serve the most disenfranchised – those who often cannot or will not speak for themselves. They are daily stigmatized for their biological based illnesses – substance use, schizophrenia, bipolar disorder – you name it – yes they are judged by it. And God forbid, you are LGBTQ, or a man or woman of color, an immigrant, or worst yet, homeless with a substance use issue. Your daily tireless dedication inspires me to be a better person, advocating for true change regardless of the cost. Although often we feel, like the REM song, “it’s the end of the world as we know it”, we can keep striving for a better world. Your hard work, medical expertise and caring is not unnoticed. You fight the good fight without personal recognition, and often at the personal cost of spending time with your loved ones. I am proud that we stand with the APA condemning racism on all fronts, imploring our state and federal officials to end all inequities regardless of race, creed, sexual preference or gender. A copy of their most recent press release is enclosed here. Our own version can be found on our website. www.papsych.org
In closing, I would like to quote two of my favorite leaders: President John Fitzgerald Kennedy, and Martin Luther King, Jr. Although they came from diversely different backgrounds, the civil war they fought together still lives on today. We might not ultimately lose our lives as they did, but may we endeavor to pass on their values to our children, our patients, our world. This may seem like the “end of the world as we know it” but we can say that we will be fine and learn to be kind and treat others with empathy and understanding in our new normal.
“ Tolerance implies no lack of commitment to one’s own beliefs. Rather it condemns the oppression or persecution of others.” –John F. Kennedy “ Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that”. –Martin Luther King, Jr. “ If you can’t fly then run, if you can’t run then walk, if you can’t walk then crawl, but whatever you do you have to keep moving forward.” –Martin Luther King, Jr.
Resident Update By Luke D. Piper, MD PGY-3, Penn State Health Department of Psychiatry lpiper@pennstatehealth.psu.edu Hello everyone, My name is Luke Piper, and I am happy to introduce myself as the PaPS resident representative for the upcoming year. I understand that my predecessors have left some sizable shoes to fill, and I will endeavor to have feet large enough to do so. Over the next couple weeks, I am hopeful to contact the program coordinators and/or directors across the state and serve as a point person for any resident-specific concerns and needs at our periodic meetings. I am grateful for this opportunity and want to make myself freely available for advice on how I may best serve in this role. My email is listed above if you would like to reach out to me. I will readily confess that when I was first approached with this responsibility, I had little idea it would take place during one of the most significant health crises of our lifetimes. I’m sure if my written words drone with the same frequency as my voice, I could bore us all recounting the myriad ways this has affected us and our patients in our daily and professional lives, but I’ve been particularly intrigued by how it’s affected the experiences of training residents. My experience is, of course, limited to that of my program, but I have been both surprised and impressed by the rapid adaptations undertaken to meet the needs of our patients, while preserving both resident safety and resident education. And I suspect that my program is not alone in meeting the demands of this uniquely challenging situation. If nothing else, my resident colleagues and I have certainly become more familiar with
video- and phone-based telepsychiatry modalities; I suspect this to be conveniently timed in a climate where there’s an increasing push for these sorts of services to meet the needs of our more access-deprived patients. At least previously, our program didn’t have any formal utilization of telepsychiatry except for conducting (fairly infrequent) overnight consultations to our emergency department, but I’ve had more than one shower thought about whether the experiences from this pandemic might prompt more structured practice of telepsychiatry during resident training. Besides the potential utility for training residents entering an increasingly technology-driven world, it’s seemed quite palatable to our patients so far, and we’ve noticed significant reductions in clinic “no-shows,” likely reflecting telepsychiatry’s ability to obviate transportation issues or other logistical concerns. Now, lest I seem a particularly overzealous cheerleader, I think many of us probably prefer to see our patients in person, and can acknowledge the limitations of telephonic communication, but especially in regard to those patients who otherwise might not have access to mental health services whatsoever, I’m cautiously optimistic for the momentum that these past couple months might give to telepsychiatry, as well as the recent immersion in the modality experienced by training residents. With COVID-19 numbers now decreasing, we are slowly but surely seeing a return to some sense of normalcy. Going forward, I will try to be particularly attentive to the needs of residents as they pertain to obstacles engendered by these uniquely challenging past several months, while being a general advocate for the next generation of young psychiatrists. I thank all responsible for this opportunity and wish all readers good health. Until next time, and with kindest regards. P E N N S Y L V A N I A P S Y C H I A T R I S T | J U LY 2 0 2 0
5
PAMED EVERYDAY HEROES Two PaPS Members Named PAMED Everyday Heros This Camp Hill, Pa. Doctor and PAMED Everyday Hero Looks to Instill Hope in People’s Lives Kawish Garg, MD is the medical director of the sleep medicine department at Geisinger Holy Spirit in Camp Hill, Pa.
He is the recipient of the Pennsylvania Medical Society’s Everyday Hero Award for May 2020. “People who suffer from mental illness are feeling hopeless,” says Dr. Garg. “I want to instill hope in people’s lives.” He chose to specialize in psychiatry – and, ultimately, to sub-specialize in sleep medicine – because he saw an opportunity to help patients reclaim their lives. “Mental health issues affect not just individuals but also families and society as a whole,” he says. In the U.S., approximately one out of every five adults experience mental illness each year. When considering a specialty, he realized that he could make a significant difference in people’s lives by training to provide muchneeded mental health care. Dr. Garg grew up in Faridkot, in the state of Punjab, India. One of his major sources of inspiration for becoming a doctor was his father, who was a high school principal. His father had dreams of being of a physician himself and encouraged his son to follow that path. In 2004, Dr. Garg completed his medical school education at Government Medical College in India. He trained as a psychiatry resident at the University of North Dakota in 2012 and then completed a sleep medicine fellowship at the University of Minnesota the following year. “Sleep and mental health are strongly tied to each other,” Dr. Garg says, noting that sleep is essential for both mental and physiological health. After his fellowship training, Dr. Garg moved to Pennsylvania and took on a leadership role as medical director for Keystone Behavioral Health in Chambersburg. In August 2016, he joined Geisinger Holy Spirit, where he currently serves as medical director of his organization’s sleep medicine department.
6
P E N N S Y L V A N I A P S Y C H I A T R I S T | J U LY 2 0 2 0
Dr. Garg sees patients at Geisinger Holy Spirit’s outpatient sleep medicine clinic. He treats a wide variety of sleep disorders such as narcolepsy, insomnia, and sleep apnea. He also oversees the functioning of the clinic’s sleep lab. Since his arrival in Pennsylvania, Dr. Garg has been actively involved in his community. He has organized mental health awareness events and has appeared on TV news programs to educate the public about sleep disorders. For the past four years, he has been a member of the Central PA Psychiatric Society and served a yearlong term as president of that organization from May 2018 through April 2019. “It was a good learning experience for me,” Dr. Garg says of his time as president. He was able to provide input on state and federal bills that could have an impact on health care. He also serves on the Board of Directors for the Pennsylvania Sleep Society. Dr. Garg’s participation in organized medicine has opened his eyes to how laws and regulations affect his profession and his patients. Recently, due to the COVID-19 pandemic, Dr. Garg and his colleagues have had to adjust their schedules to accommodate telehealth visits with patients. He has seen that COVID-19 has had an impact on mental health and on sleep patterns for his patients. Dr. Garg encourages them to maintain their daily routines as much as possible and recommends exercise and meditation as ways to ease stress and anxiety. Dr. Garg stresses how much he admires his colleagues at the sleep medicine clinic. He appreciates their dedication and their ability to face challenges and keep the clinic operating smoothly. He credits his wife Shefali Gupta, MD for being the reason for his success. They have always supported one another. Dr. Garg and his wife have two young children, ages 7 and 3. He loves spending time with his family and with a close circle of friends he has developed during his time in Central Pennsylvania. Dr. Garg’s guiding principle as a physician is a simple but essential one - He believes strongly that he can help patients improve their lives.
“Seeing patients get better is my major motivation,”
Reprinted with permission from the Pennsylvania Medical Society.
A Message from PaPS President Richard R. Silbert, MD, DLFAPA Dear Pennsylvania Psychiatric Society Member,
Matthew Berger, MD, a psychiatrist from Moosic, Pa., has been recognized by the Pennsylvania Medical Society (PAMED) as an Everyday Hero on the Frontline of COVID-19. PAMED’s Everyday Hero Award is designed to showcase talented physicians who probably don’t view themselves as heroes, but to patients and colleagues they are. The statewide organization is increasing the number of physicians it recognizes during the COVID-19 pandemic. Colleagues say Dr. Berger embodies everything that is needed in times of crisis. He have kept his practice open during the pandemic and continues to serve the mental health needs of patients who are particularly impacted by such a catastrophic event.
“ He has remained calm, optimistic, and reassuring at a time when many people react with fear, isolation, and anger,” “He has remained calm, optimistic, and reassuring at a time when many people react with fear, isolation, and anger,” says colleague Patricia Reynolds. “He serves as a steady voice that reminds his patients and staff that this too shall pass and we are in it together. He walks the walk with his staff and is very much both the captain of the team but also deep in the trenches.”
As President of the Pennsylvania Psychiatric Society, the Executive Committee requested I share with you an update on PaPS staffing. As you know, Deborah Shoemaker has passionately served as a devoted Executive Director and Lobbyist for PaPS for the last 14 years. Our staffing structure has been revised and Deb will continue to focus on lobbying and advocacy efforts for PaPS in the role as Lobbyist. Jennifer Redmond will assume the role of Executive Director to focus on administrative tasks and council governance. Jenn was previously with the Society as Associate Executive Director. This will allow Deb to make advocating for the Society her top priority while Jenn’s priority will be on the day to day tasks of running the Society. Deb will also continue in her work with the Ethics Committee. Dawn Losiewicz will continue as Deputy Executive for the chapters. The three will work as a team to serve the needs of PaPS members. We are excited to welcome Jenn back to the team and look forward to the continued passion Deb brings to our advocacy efforts. We all thank you Deb, for the many years you have given and will give of service to the Society. You can still reach the office at 1-800-422-2900 and papsych@ papsych.org if you have any questions or need assistance.
Richard R. Silbert, MD, DLFAPA President
Reynolds and her staff nominated Dr. Berger for this award. Dr. Berger specializes in caring for patients with mood disorders, psychotic disorders, personality disorders, and addiction. Dr. Berger focuses on medication management as well as alternative treatments, including TMS, ECT, and Spravato for the treatment of depression, anxiety, and other mood disorders. Non-medication modalities are also utilized, which include Neuroflow and Freespira to help cope with mood issues and stressors. He is affiliated with medical facilities such as Berwick Hospital Center, Moses Taylor Hospital, First Hospital-Wyoming Valley, Regional, Luzerne County Prison, Just Believe Recovery, Casey House, and Devereux Pocono Center, also multiple long-term care facilities.
Deborah Shoemaker PaPS Lobbyist
Jennifer Redmond PaPS Executive Director
Patients and medical colleagues can nominate PAMED member physicians for this award at www.pamedsoc.org/EverydayHero.
P E N N S Y L V A N I A P S Y C H I A T R I S T | J U LY 2 0 2 0
7
How Can You Advocate for Your Society and Your Patients During This Uncertain Time? Donate to Our PAC! We are adjusting to the new “normal” during this pandemic. For many of our members, practice settings and method(s) of treatment have changed. Regardless of your daily routine, and ever-changing political, economic, and societal climate around us, the Society’s dedication is unwavering and unchanged. We are more dedicated than ever to provide grassroots advocacy for our members on the state and local level.
So, what can you do to assist our efforts?
Donate to our Political Action Committee (PAC). The Psychiatric Physicians of Pennsylvania PAC (or PPP-PAC) will be embarking on a fundraising campaign in the next few weeks. Our campaign called “20 Reasons to Donate $20 to the PPP-PAC in 2020” will highlight some of our top advocacy issues along with our efforts.
Here are few highlights:
• Reasons to Donate $20 to the Psychiatric Physicians of Pennsylvania’s Political Action Committee (PPP-PAC) in 2020 • Access to key state policymakers who positively or negatively impact the lives of your patients and their families. • Deborah Ann Shoemaker, PaPS Executive Director, is also a registered lobbyist representing our interests at the Capitol, serving on numerous key advisory committees under the jurisdiction of the Wolf Administration. • The Society communicates regularly with key policymakers within the Wolf Administration, often solicited for member clinical expertise on proposed policies affecting individuals with mental health and substance use needs.
Legislative Focus and Grassroots Advocacy • Telemedicine: laboring closely with the APA, and various national and statewide provider stakeholder groups to ensure that access to quality, evidence-based, confidential and patient safe telepsychiatry treatment is available for all individuals seeking it and that providers are compensated appropriately. • Public Safety Measures: working in concert with House and Senate legislators in drafting and advancing proposed legislation to create Extreme Risk Protection Orders/Red-Flag laws to keep guns out of the hands of individuals who pose a risk to themselves or others during a mental health emergency. • Expansion of Medical Marijuana Program: continued vigilance in opposing arbitrary, non-clinically based additions to the list of eligible conditions for the use of medical marijuana across the commonwealth by the PA Medical Marijuana Advisory Board. The Society has petitioned to remove anxiety disorder, Opiate Use Disorder, and other related mental health conditions from the list of eligible conditions. • COVID-19: we are your voice and resource for all things COVID-19, participating in policy briefings and informational webinars, laboring closely with APA and our medical colleagues on grassroots advocacy efforts to provide medical liability protections for physicians. • We are in an election year where decisions at the state level affect the federal level. Pennsylvania is a battleground state so your $20 matters! Please thoughtfully consider sending a personal donation today, made payable to the PPP-PAC. Personal donations can also be made via credit card by completing the donation portion below. It is an investment in your future. We have enclosed a copy of our donation form here so that you can send the donation today.
Name: (if using a credit card, please print name as it appears on the card)
Personal (not corporate) check for $
Charge my credit card for $ *we cannot accept American Express
MasterCard
enclosed (payable to PPP-PAC) Visa
Card # Exp. Date
CVV No. (3-digit number on back of card)
Card’s Billing Address: Signature Please fax completed forms to 855-918-3611 Or mail your form to: PA Psychiatric Society, Attention: Dawn Losiewicz, P. O. Box 8820, Harrisburg, PA 17105-8820 (Contributions to PPP-PAC are not deductible for income tax purposes.)
8
P E N N S Y L V A N I A P S Y C H I A T R I S T | J U LY 2 0 2 0
Discover
TELEPSYCHIATRY
Muhamad Aly Rifai, MD, FAPA, FAPM, FACLP Professor of Medicine and Psychiatry, Geisinger Commonwealth School of Medicine. Immediate Past President, Lehigh Valley Psychiatric Society
An Update on Telepsychiatry Telepsychiatry is defined as the provision of psychiatric services to patients through communication means such as private video conferencing and telephone exchange. Over the past fifteen years, government and state agencies slowly adopted policies to approve the use of telepsychiatry to provide psychiatric services to patients living in underserved and rural areas. Despite overwhelming published peer-reviewed evidence of the effectiveness of telepsychiatry in improving overall morbidity, mortality, and disease-specific outcomes of patients, the use of telepsychiatry services remained restricted to certain demographics and those living in underserved and rural areas. In April 2014, I wrote an article in the Pennsylvania Psychiatrist about telepsychiatry and called for its wide implementation because it provided increased access to services and has shown improved outcomes. It was not until February 2020 and because of the Coronavirus Disease 2019 (COVID-19) pandemic that government and state agencies as well as private insurers speedily approved the wide adoption of telepsychiatry services to provide psychiatric services to all patients in the US who are under a stay at home order because of the social distancing guidelines. Additionally, most restrictions on the provision of telepsychiatry services were lifted by executive orders. For billing and reimbursement purposes private video conferencing telepsychiatry services were also equated with telephone-only telepsychiatry services. In addition to relaxing the billing and reimbursement rules and regulations, government and state agencies also relaxed the privacy guidelines allowing to use communication methods that may not have overall privacy protections. For example, the use of Apple FaceTime, Zoom and Skype were approved despite the lack of any privacy measures that are compliant with the Health Information Portability and Accountability Act (HIPAA) of 1996. For those psychiatrist colleagues who had not been involved in the practice of telepsychiatry this speedy and abrupt change in the practice of psychiatry took some getting used to. And while there is an adjustment for both patients and psychiatrists, many immediately started seeing the value of utilizing new technology to streamline psychiatric services more efficiently and safely. For most patients, they saw a reduction in travel times and enjoyed using time off from work for things other than attending medical appointments. Face contact with their psychiatrist, as well as the implementation of electronic prescribing has impressed them because of the ease and convenience of telepsychiatry. It is very possible that the majority of our patients would not prefer to go back to traditional appointments, and
would rebel (as I have been told by many of my patients) against insurers and government agencies if asked to return things to their pre- COVID-19 state. It is quite interesting that voluminous evidence-based peer-reviewed research on the utility of telepsychiatry gained boosted momentum. Old research on telephone-administered behavioral therapy had already showed that the outcome was the same as to face-to-face therapy. It was at the behest of a letter from the Medical Director of the American Psychiatric Association and other medical specialty organizations that government and state agencies decided to reverse course and accept telephonic contact as an equivalent to video conferencing contact in terms of efficacy and reimbursement. Nonetheless, for patients with severe psychiatric illness and those dealing with extreme issues such as suicidal ideation, telepsychiatry may have made things more difficult. And there is significant worry that access to in person face-to-face services may be curtailed once the COVID-19 pandemic subsides.
“Telepsychiatry is here to stay, patients are demanding it.� Despite the psychiatric burden that the COVID-19 pandemic has afflicted many of our patients in terms of anxiety, depression, loneliness, despair, and psychiatric decompensation there is a developing greater sense of community in person or virtually. Even though people are socially distancing and not attending in person worship services, bowling leagues or baseball games people are really trying to connect virtually. And while our patients can talk from the comfort of their living rooms, there are some challenges with patients wanting to keep their psychiatric issues private and away from their families. Telepsychiatry is here to stay, patients are demanding it. It is quite exciting that we may be able to reach more people to broaden our outreach and improve access all coupled with well-known improved outcomes. Many patient advocacy groups have started their efforts to ask government and state agencies as well as private insurers to make some or all of the telepsychiatry changes permanent. It is our hope that our psychiatrist colleagues will support those efforts and adopt their practice to the new reality of virtual care through telepsychiatry. It is quite important that those colleagues with familiarity in Telepsychiatry share that experience and assist other colleagues.
P E N N S Y L V A N I A P S Y C H I A T R I S T | J U LY 2 0 2 0
9
Pennsylvania Psychiatric Society Committee Interest Form One of the most valuable ways a member can contribute to the growth of the Society is to participate on a committee. We invite all members to become involved. If you have an area of expertise, an area of interest or just want to get involved, we want to hear from you.
Government Relations
Clinical
Develops and implements membership recruitment and retention programs, makes recommendations to the PaPS council on dues relief requests, and makes recommendations to the PaPS council on Distinguished Fellow candidates. The committee performs most of its work via email with an occasional conference call/Zoom.
Monitors policies proposed by the Pennsylvania Departments of Aging, Corrections, Drug and Alcohol Programs, Health and Public Welfare and any other entities under the administration of the governor. Reviews bills introduced in the Pennsylvania General Assembly and makes recommendations to the Government Relations committee and PaPS Council on issues related to substance abuse, older adults with mental health issues and child and adolescent mental health issues. Reviews proposed Department of Public Welfare and VA hospital policies and makes recommendations to the Government Relations committee and PaPS council on issues related to state and VA hospitals. This committee is called upon as needed with an occasional conference call/Zoom.
Education
Develops and conducts the Society’s patient safety/risk management CME program annually. This committee performs most of its work via email with occasional conference calls/Zoom.
Ethics
Reviews ethical complaints made on members, investigates possible ethical violations, renders decisions in each case as to what, if any, sanctions are needed, makes recommendations to the PaPS council, and informs the APA as to the findings in each case as per the APA’s publication, The Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry. Members of this committee are on call as needed.
Monitors bills introduced in the Pennsylvania General Assembly and makes recommendations to the PaPS council on legislative and regulatory issues affecting the specialty and health care public policy.
Membership
Third Party Payer
Reviews and addresses third party payer issues raised by members which interferes with patient safety or best practice. This committee is called upon as needed with an occasional conference call/Zoom.
Task Force on Wellness and Burnout
Initiates discussion and provides guidance to PaPS Council and Executive Leadership on physician wellness, including addressing physician burnout, physician suicide prevention and overall wellness. Reviews research and creates proposed policies and makes recommendations to the Education and Government Relations committee’s and PaPS council on issues that can promote member wellness and/or educational materials for use in state and chapter educational events. This committee is called upon as needed with an occasional conference call/Zoom.
Early Career Psychiatrist (ECP) Task Force
Initiates discussion and provides guidance to PaPS Council and Executive Leadership on areas of interest for our Early Career Psychiatrist members, including addressing membership recruitment/ retention, paths to state and chapter leadership opportunities and/ or educational opportunities for use in state and chapter educational events. The PaPS ECP and CPPS ECP representatives serve as co-chairs of this committee. This committee is called upon as needed with an occasional conference call/Zoom.
Please check off the committee(s) you are interested in and fax the completed form to: PaPS Attention: Dawn Losiewicz at 855-918-3611 Name: MD or DO: (Please print) Telephone Number: E-Mail Address:
I am interested in participating in the following committee(s): Clinical
Membership
Education
Third Party Payer
Ethics
Task Force on Wellness and Burnout
Government Relations
Early Career Psychiatrist (ECP) Task Force
FAX BACK completed form to: Dawn Losiewicz, PaPS at 855-918-3611.
10
P E N N S Y L V A N I A P S Y C H I A T R I S T | J U LY 2 0 2 0
WELCOME Meet Your 2020-2021 Executive Committee New officers of the Pennsylvania Psychiatric Society (PaPS) were formally installed at the Virtual Annual Business Meeting on May 16, 2020. Richard R. Silbert, MD, DLFAPA serves as president. He is senior medical director at Community Care Behavioral Health Organization (CCBHO) for Substance Use Disorders, (part of UPMC) and is an associate professor of psychiatry at The Geisinger Commonwealth Medical College. Dr. Silbert won the 2019 NAMI Luzerne and Wyoming counties Lester Varano Advocacy Award, served as the past president of the Greater Northeast PA Chapter of the American Foundation for Suicide Prevention (AFSP) and co-chairs a Scranton area treatment committee that is part of a stop heroin/opioid overdose coalition
Dhanalakshmi Ramasamy, MD, FAPA serves as president-elect of PaPS. Dr. Ramasamy is a child and adolescent psychiatrist at the Lehigh Valley Health Network, and a medical director of LVPG CCAPP program. She is a Clinical Assistant Professor of Psychiatry, University of South Florida, and a past president of Lehigh Valley Psychiatric Society. She also serves as a psychiatrist representative to PennDOT and serves as a member of Regional Child and Adolescent psychiatric association.
Hope S. Selarnick, MD, DFAPA, FASAM serves as vice president. Dr. Selarnick is director of addiction services and medical director of the opioid treatment program at the Corporal Michael J. Crescenz VA Medical Center in Philadelphia. She is a past president of the Philadelphia Psychiatric Society (PPS) where she is a former chair and member of the Women’s Committee. Dr. Selarnick is also active on the PPS/PaPS Education Committees.
Kavita K. Fischer, MD, FAPA serves as treasurer. Dr. Fischer is regional medical director at Community Care Behavioral Health Organization in affiliation with University of Pittsburgh Medical Center. Her focus with Community Care is on quality assurance for members throughout different levels of care including drug and alcohol treatment with a focus on the Blair county region. She also serves as vice president of OCD Pennsylvania which is an affiliate of the International OCD Foundation while maintaining a private practice with a focus on anxiety and mood disorders.
Usman Hameed, MD, DFAPA serves as secretary. Dr. Hameed is board certified in psychiatry as well as Child and Adolescent Psychiatry. He serves as the director for Neural and Behavioral Science Course, Psychiatry Clerkship and Acting Internship for the Penn State College of Medicine. He supervises medical students, residents, and fellows in their clinical and research work. He is a Distinguished Fellow of the American Psychiatric Association, as well as the American Academy of Child and Adolescent Psychiatry. His areas of interest include innovation in medical education, internalizing and externalizing behaviors in children and adolescents.
P E N N S Y L V A N I A P S Y C H I A T R I S T | J U LY 2 0 2 0
11
