As you know, I observe and assess several hundred psychiatric treatment plans each year as I am mock-examining psychiatrists preparing for their Psychiatry and their Child Adolescent Psychiatry oral boards. There is a small, simple concept to keep in mind during your presentation of the treatment plan that can help you avoid this common shortcoming.
The problem is this: the treatment plan for most patients is long and complex. Not infrequently, oral board candidates get lost and present a treatment plan lacking clarity and completeness. The following image presents the simple concept that will help you achieve laser-clarity in the treatment plan. The treatment plan must address problems that fall in two categories: current problems and anticipated problems.
Psychiatric treatment plans must address both current problems (Acute Treatment) as well as anticipated problems (Maintenance Treatment)
An example to make this clear. When a patient with Alcohol Dependence currently has out of control drinking, that is a current problem. When this same patient with Alcohol Dependence is currently in recovery (not drinking), he faces an anticipated problem, one not currently present but one highly likely to occur in the future. Why is a problem not currently present even a problem? Because most (MOST!) psychiatric conditions are recurrent. Even periods of being symptom-free and dysfunction-free, are likely to be followed by periods of recurrence. In fact, one of my greatest insights into treating patients with addictions is this – I learned to think of them and to treat them like my patients with Bipolar Disorder. That means I assumed and anticipated that a relapse would occur at some point in their future.
I know that this simple insight is obvious and not much of an insight at all. But its simple clarity, made me sooo much more effective and also confident in treating patients with substance-use disorders. I realized my job was to help them acheive sobriety when they were using AND it was my job to help them maintain their sobriety when they were sober. And, by the way, it is the latter part of the job, providing optimal maintenance treatment is the weak point of many of the treatment plan presentations I observe.
Now, I want you to think through all the psychiatric conditions that are chronically recurrent. Almost all! Mood, anxiety, psychotic, substance-use, somatoform, sleep, sexual, eating disorders. So is delirium, suicide risk, and risk of violence.
Today’s Quote
“He is able who thinks he is able.” Buddha
Thanks and happy studies …
Jack Krasuski, MD
Executive Director
877-225-8384
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