Not So Involuntary: Hospitalists and Psych Holds

by Dr. Atashi Mandal
by Dr. Atashi Mandal MD He sat on the gurney, with averted eyes and contorted posture, as to avoid my encroaching examination. The usual jargon populated my assessment: psychomotor retardation, flat affect, poor vocalization… I glanced at his intake form and noted that he had been admitted to the emergency treatment unit for suicidal ideation, removed from a family with a history of incarceration, drug use and neglect. At my coaxing to face forward, I glimpsed at the tapestry of well healed linear scars from previous cutting attempts. I now needed to medically clear him so that he could receive his next placement in the “most appropriate setting”.  But I wondered if checking off boxes and signing a form was the most I could do for him. Sadly, as hospitalists, this scenario is one most, if not all, of us have encountered. We have also grown accustomed to separating medical…
Dr. Atashi Mandal is a practicing adult and pediatric hospitalist in Los Angeles and Orange County areas. She is also a member of SHM’s Public Policy Committee.

Yes, Yes, Yes!

by Dr. Anna Arroyo Plasencia, SFHM
by Anna Arroyo Plasencia, MD, SFHM You have probably already seen SHM's Action Alert, Crisis in the Mental Health System.  I would have missed this item if a colleague hadn't mentioned it, though, this could not have come at a better time. America's mental health system is broken! As hospitalists, we are constantly asked to care for patients whose medical illnesses are complicated by their mental ones. This could not be truer than for addiction.  A colleague recently asked me to provide a curbside consult for a psychiatric boarder she was treating for alcohol and opioid withdrawal. Interestingly, I was also this patient's admitting hospitalist the week before. In addition to my day job in hospital medicine, I am a medical toxicologist and an addiction medicine specialist. My background provides a unique opportunity for me to become involved in patient care through management of the consequences of overdose. I am also…
Dr. Anna Arroyo Plasencia, SFHM is a hospitalist and medical toxicologist at Washington University School of Medicine in St. Louis, Missouri. In addition to Internal Medicine and Medical Toxicology, she is board certified in Pediatrics and Addiction Medicine and serves as co-director of a toxicology and addiction medicine clinic. Dr. Arroyo Plasencia completed her residency in Internal Medicine and Pediatrics and fellowship in Medical Toxicology at Indiana University School of Medicine. In her free time, she enjoys traveling and spending time with family.