D epartment
of
M edicine
Con ne c ti ng T e c h n o lo g y , Ed uca t i o n a n d D i s cove ry w ith H um anis m in Me dicine
Vol. 9 Issue 2 Apr. 2020
UT Medical Center’s Outpatient Psychiatry Clinic The Internal Medicine Clinic at the University of Tennessee Medical Center has been providing outpatient care for members of the East Tennessee community since July 2006. Internal Medicine and OB/GYN residents, under the supervision of their board-supervised attendings, provide quality primary care, acute care (through the PRN clinic), and hospital followup care (through the REACT clinic). The outpatient psychiatry clinic was added in 2018 in order to provide patients with more comprehensive care. Psychiatrist and Assistant Professor Dr. Paul Miller, sees patients 5 half-days per week and supervises the residents who see patients Friday mornings. The clinic also serves as the teaching setting for third-year medical students during their psychiatry rotation. Treatment is available for adults who are dealing with any of the major mental health issues including depression, anxiety, mood disorders, psychotic disorders, dementia, and addiction. TennCare is accepted, which removes a barrier that many patients face to getting mental health care. “Most, though not all, of our patients are on TennCare,” notes Dr. Miller. “It’s a busy clinic and there is a lot of need out there.” Perhaps one of the most important roles the clinic plays is to integrate medical and mental health outpatient care for people who have both medical and mental healthcare needs. People with psychiatric illness are more likely to have medical illnesses than the general population, and they have higher rates of death. They are also especially vulnerable to health care disparities, which may contribute to the fact that they often do not seek medical care until they are in crisis. Patients whose psychiatric problems and medical problems compound one another frequently lack enough resources to manage their health. Depression, fatigue, hopelessness, and anxiety can interfere with one’s ability, motivation, and trust to seek care and comply with recommendations. This is amplified for patients with delusions related to authority or to the
helping professions. Additionally, geographic, financial, insurance, and housing-related barriers can interfere with access to treatment. Dr. Miller espouses a holistic treatment philosophy, tailoring each plan of care to the needs of the individual patient, including the judicious use of medications. “We use a fairly conservative approach to prescribing,” he says. He and the residents strive to integrate nonpharmacological elements into patient care, noting that psychiatric medications are far more effective when used in conjunction with other modalities. These modalities -- primarily cognitive-behavioral therapy and other talk therapies – are mostly provided by way of referrals to practitioners in the community. “Developing a context for an individual’s symptoms is an essential part of mental health care,” said Dr. Miller. “Setting a reasonable expectation for medications while also developing a plan to address symptoms that may not respond to psychotropics is critical to delivering satisfactory care.”
Points of View
this department.” She remembers when there were only 8 residents, of which 5 were categorical and 3 were “flexible.” Now the program has grown to 42 residents; including the transitional years. Sissy knows that she and Kristi play a vital role in the health and well-being of the residents. Sissy reminisces about all of the changes that have occurred and the advances in technology over the last 40 years: such as fond memories of the electric typewriter (Selectrics) which was common-place in the office as well as how the Graduate School of Medicine was the first department to have an IBM Displaywriter installed. Sissy recounts that another difficult change in the workplace occurred after she was “left to keep the department alive, at the age of 22 years old, when
This feature is devoted to Melinda “Sissy” Ensor, our Residency Coordinator, for her 40 years of dedicated and enthusiastic service to the UTGSM. A native of Knoxville, TN, Sissy grew up in the city but moved to a farm in Blount County at 12 years old. She graduated from Lanier High School and took a few evening classes at UTK while doing administrative support work. On February 2nd, 1980, Dr. Alfred Beasley, Chair of Rajiv Dhand, MD, Chair the Department of Medicine and Dean of Graduate Medical Education, hired her. Sissy recalls, “I intended to work for the GSM for 3 to 4 years,” but she decided to stay because “the job is never boring and I found fulfillment within my role for
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