For Residents

Another year, another meeting for the American Academy of Dermatology (AAD) over, and this one certainly took the AAD to new heights! The “mile-high city” graciously welcomed us as dermatologists from all over the world convened in Denver. Luckily, the big blue bear (pictured here) never did break through the convention center wall, and a bit of chilly weather notwithstanding, the meeting was a great success!

Photograph courtesy of Benjamin Lin, MD, Los Angeles, California.

As always, with so many interesting things going on and so many dermatology luminaries speaking at the same time, it can be quite difficult to navigate the conference and decide which lectures to attend. If there is a specific research topic that sparks your interest, no doubt there was a captivating and focused talk for you to attend. For example, those interested in the use of biologics in dermatology aside from psoriasis may have attended the excellent, standing room only forum “Biologic Therapy in Dermatology Beyond Psoriasis.” But for those who just wanted a sampling of hot topics and board-relevant facts, there certainly was already a very full schedule.

If your program allows you to arrive a day early for the conference, the “Practice Management Symposium for Residents” is highly suggested. Although it does seem geared toward more senior residents with topics such as contract evaluation, how to set up an office, and coding, this information takes some time (and perhaps repetition) to settle in. Because it is free for residents, why not attend more than once during your residency?

“Resident Jeopardy” always is a popular event. Whether or not you have a horse in the race, it is exciting to watch the team try to answer the minutiae of the minutiae, and it is always a great and fun learning experience. Along a similar strain, “Boards Blitz” is another highly attended session for residents. Bridging basic dermatology to dermatopathology to an intense dermatologic surgery session, this symposium paints a broad brushstroke of what is important for dermatology residents to know.

If you could get in, “High Yield ‘Power Hour’ for Residents,” which actually spanned more than an hour, was a great experience. Rapid-fire, boards-style questions: what dermatology resident does not love that? But maybe you were one of those people who could not get in because the room was at capacity; you could have gone next door to watch your peers present their findings at the “Residents and Fellows Symposium,” spanning a broad range of both clinical and basic science research.

If dermatopathology is your cup of tea, there were many forums, symposia, and lectures right up your alley. Either way, a very good session for all dermatology residents is the “Basic Self- assessment of Dermatopathology.” Over 2 hours you get to go through 60 slides (2 minutes each) and pick your preferred answer in a multiple-choice format. The discussion session the next morning could be either reassuring or maybe a bit of a wake-up call! For those dermatopathology pros, there is the “Advanced Self-assessment of Dermatopathology” too. Of course, if you are ready for that course, you probably were also excited for the dermatopathology bowl, conducted yearly at the Dermpath Diagnostics booth on the exhibition floor. Compete head-to-head against other programs around the country and make the diagnosis!

Every year, the plenary session is a signature series of lectures. It is a real privilege to hear from the leadership of the AAD about the most pressing issues in our specialty along with a spotlight guest lecture.

This year’s meeting also saw a change in the late-breaking research symposium with a new name, “The Latest in Dermatology Research,” now with a 2-day format. Who does not want to be on the cutting edge of dermatology?

Lastly, if you are not too comfortable with that little polarized light doohickey in your pocket, numerous sessions focusing on dermoscopy were available from “Basic Dermoscopy” to “Advanced Dermoscopy” and specialized sessions on topics such as “Hair and Scalp Dermoscopy.”

Of course, the AAD would not be the AAD without some fun, so make sure to hit up the resident’s reception to see old friends, fellow interns, people from the interview trail, and “that” guy or girl who everyone remembers (for good or bad). If you signed up early enough, perhaps you got one of the complimentary resident spots at the Women’s Dermatologic Society luncheon, which is a great event with interesting talks and great company; you do not have to be a woman to go!

I hope you enjoyed the AAD this year; are you excited yet for San Francisco next year?

We want to know your views! Tell us what you think.

Another year, another meeting for the American Academy of Dermatology (AAD) over, and this one certainly took the AAD to new heights! The “mile-high city” graciously welcomed us as dermatologists from all over the world convened in Denver. Luckily, the big blue bear (pictured here) never did break through the convention center wall, and a bit of chilly weather notwithstanding, the meeting was a great success!

Photograph courtesy of Benjamin Lin, MD, Los Angeles, California.

As always, with so many interesting things going on and so many dermatology luminaries speaking at the same time, it can be quite difficult to navigate the conference and decide which lectures to attend. If there is a specific research topic that sparks your interest, no doubt there was a captivating and focused talk for you to attend. For example, those interested in the use of biologics in dermatology aside from psoriasis may have attended the excellent, standing room only forum “Biologic Therapy in Dermatology Beyond Psoriasis.” But for those who just wanted a sampling of hot topics and board-relevant facts, there certainly was already a very full schedule.

If your program allows you to arrive a day early for the conference, the “Practice Management Symposium for Residents” is highly suggested. Although it does seem geared toward more senior residents with topics such as contract evaluation, how to set up an office, and coding, this information takes some time (and perhaps repetition) to settle in. Because it is free for residents, why not attend more than once during your residency?

“Resident Jeopardy” always is a popular event. Whether or not you have a horse in the race, it is exciting to watch the team try to answer the minutiae of the minutiae, and it is always a great and fun learning experience. Along a similar strain, “Boards Blitz” is another highly attended session for residents. Bridging basic dermatology to dermatopathology to an intense dermatologic surgery session, this symposium paints a broad brushstroke of what is important for dermatology residents to know.

If you could get in, “High Yield ‘Power Hour’ for Residents,” which actually spanned more than an hour, was a great experience. Rapid-fire, boards-style questions: what dermatology resident does not love that? But maybe you were one of those people who could not get in because the room was at capacity; you could have gone next door to watch your peers present their findings at the “Residents and Fellows Symposium,” spanning a broad range of both clinical and basic science research.

If dermatopathology is your cup of tea, there were many forums, symposia, and lectures right up your alley. Either way, a very good session for all dermatology residents is the “Basic Self- assessment of Dermatopathology.” Over 2 hours you get to go through 60 slides (2 minutes each) and pick your preferred answer in a multiple-choice format. The discussion session the next morning could be either reassuring or maybe a bit of a wake-up call! For those dermatopathology pros, there is the “Advanced Self-assessment of Dermatopathology” too. Of course, if you are ready for that course, you probably were also excited for the dermatopathology bowl, conducted yearly at the Dermpath Diagnostics booth on the exhibition floor. Compete head-to-head against other programs around the country and make the diagnosis!

Every year, the plenary session is a signature series of lectures. It is a real privilege to hear from the leadership of the AAD about the most pressing issues in our specialty along with a spotlight guest lecture.

This year’s meeting also saw a change in the late-breaking research symposium with a new name, “The Latest in Dermatology Research,” now with a 2-day format. Who does not want to be on the cutting edge of dermatology?

Lastly, if you are not too comfortable with that little polarized light doohickey in your pocket, numerous sessions focusing on dermoscopy were available from “Basic Dermoscopy” to “Advanced Dermoscopy” and specialized sessions on topics such as “Hair and Scalp Dermoscopy.”

Of course, the AAD would not be the AAD without some fun, so make sure to hit up the resident’s reception to see old friends, fellow interns, people from the interview trail, and “that” guy or girl who everyone remembers (for good or bad). If you signed up early enough, perhaps you got one of the complimentary resident spots at the Women’s Dermatologic Society luncheon, which is a great event with interesting talks and great company; you do not have to be a woman to go!

I hope you enjoyed the AAD this year; are you excited yet for San Francisco next year?

We want to know your views! Tell us what you think.

Another year, another meeting for the American Academy of Dermatology (AAD) over, and this one certainly took the AAD to new heights! The “mile-high city” graciously welcomed us as dermatologists from all over the world convened in Denver. Luckily, the big blue bear (pictured here) never did break through the convention center wall, and a bit of chilly weather notwithstanding, the meeting was a great success!

Photograph courtesy of Benjamin Lin, MD, Los Angeles, California.

As always, with so many interesting things going on and so many dermatology luminaries speaking at the same time, it can be quite difficult to navigate the conference and decide which lectures to attend. If there is a specific research topic that sparks your interest, no doubt there was a captivating and focused talk for you to attend. For example, those interested in the use of biologics in dermatology aside from psoriasis may have attended the excellent, standing room only forum “Biologic Therapy in Dermatology Beyond Psoriasis.” But for those who just wanted a sampling of hot topics and board-relevant facts, there certainly was already a very full schedule.

If your program allows you to arrive a day early for the conference, the “Practice Management Symposium for Residents” is highly suggested. Although it does seem geared toward more senior residents with topics such as contract evaluation, how to set up an office, and coding, this information takes some time (and perhaps repetition) to settle in. Because it is free for residents, why not attend more than once during your residency?

“Resident Jeopardy” always is a popular event. Whether or not you have a horse in the race, it is exciting to watch the team try to answer the minutiae of the minutiae, and it is always a great and fun learning experience. Along a similar strain, “Boards Blitz” is another highly attended session for residents. Bridging basic dermatology to dermatopathology to an intense dermatologic surgery session, this symposium paints a broad brushstroke of what is important for dermatology residents to know.

If you could get in, “High Yield ‘Power Hour’ for Residents,” which actually spanned more than an hour, was a great experience. Rapid-fire, boards-style questions: what dermatology resident does not love that? But maybe you were one of those people who could not get in because the room was at capacity; you could have gone next door to watch your peers present their findings at the “Residents and Fellows Symposium,” spanning a broad range of both clinical and basic science research.

If dermatopathology is your cup of tea, there were many forums, symposia, and lectures right up your alley. Either way, a very good session for all dermatology residents is the “Basic Self- assessment of Dermatopathology.” Over 2 hours you get to go through 60 slides (2 minutes each) and pick your preferred answer in a multiple-choice format. The discussion session the next morning could be either reassuring or maybe a bit of a wake-up call! For those dermatopathology pros, there is the “Advanced Self-assessment of Dermatopathology” too. Of course, if you are ready for that course, you probably were also excited for the dermatopathology bowl, conducted yearly at the Dermpath Diagnostics booth on the exhibition floor. Compete head-to-head against other programs around the country and make the diagnosis!

Every year, the plenary session is a signature series of lectures. It is a real privilege to hear from the leadership of the AAD about the most pressing issues in our specialty along with a spotlight guest lecture.

This year’s meeting also saw a change in the late-breaking research symposium with a new name, “The Latest in Dermatology Research,” now with a 2-day format. Who does not want to be on the cutting edge of dermatology?

Lastly, if you are not too comfortable with that little polarized light doohickey in your pocket, numerous sessions focusing on dermoscopy were available from “Basic Dermoscopy” to “Advanced Dermoscopy” and specialized sessions on topics such as “Hair and Scalp Dermoscopy.”

Of course, the AAD would not be the AAD without some fun, so make sure to hit up the resident’s reception to see old friends, fellow interns, people from the interview trail, and “that” guy or girl who everyone remembers (for good or bad). If you signed up early enough, perhaps you got one of the complimentary resident spots at the Women’s Dermatologic Society luncheon, which is a great event with interesting talks and great company; you do not have to be a woman to go!

I hope you enjoyed the AAD this year; are you excited yet for San Francisco next year?

We want to know your views! Tell us what you think.

With the annual meeting of the American Academy of Dermatology (AAD) set in the “mile-high city” now behind us, we must begin to convert didactic sessions into improved outcomes in our daily patient encounters. The enormous variety of lectures and frequently overlapping schedules can make this event a whirlwind for unseasoned attendees. I aim to enlighten those attending future meetings about individual sessions of particularly high value to the dermatologist in training. As a disclaimer, my primary interests are in medical dermatology, so the content of the courses I recommend is by no means comprehensive; however, residents need to have a solid fund of medical knowledge to function in any practice setting and, perhaps more importantly, to pass the boards examination!

I think the session that takes the cake for utility and value for residents is “High Yield ‘Power Hour’ for Residents,” which was led by a group of education-oriented Harvard University dermatologists. The power “hour” in fact lasted 2 hours, during which there was a variety of material presented covering pediatric dermatology, allergic dermatitis, infectious disease dermatology, blistering disorders, and pharmacology. The presenters showed incredible enthusiasm for their respective topics, and their passion also was evident in the high-yield handouts that they provided that were jam-packed with tables, bullet points, and frequently tested material. I would recommend that attendees save or print the handouts and avoid taking extensive notes on them during the session. Sit back, relax, and just soak in the lectures; later on, review the handouts. Also, be sure to arrive early—this session fills up fast—and fill out your evaluation! These lecturers deserve credit for their presentations and deserve a much larger room to accommodate residents that are otherwise willing to sit on the floor, crowd against the walls, and peek in through the doorway to listen.

I also feel residents benefit from lectures that provide us with practical information regarding complicated medical problems. I greatly enjoyed the symposium “Biologics: Perils and Promise” led by Canadian Dermatology Association President Richard Langley, MD. This conglomerate of experts addressed the risk for infection and malignancy with the use of biologics as well as pediatric use. The symposium also touched on the cardiovascular risk inherent in psoriasis and new developments suggesting that the treatment of psoriasis decreases overall systemic inflammation and possibly even cardiovascular risk. Another symposium in the same vein was “Systemic Therapies for Dermatologists: A Comprehensive Review and Update,” which was divided into short lectures discussing agents from acitretin to Zelboraf (vemurafenib). Expert insight on the use of these drugs was invaluable for those of us who train in programs where we are not frequently exposed to these agents.

For those residents interested in an overview of dermatopathology, “Dermatopathology Made Simple” led by Christine Ko, MD, was a lightning-fast tour through the subject. Dr. Ko categorized diagnoses based on pattern and also compared similar pathology side-by-side, focusing on key differences to help cinch the correct diagnosis. Although this talk was only 2 hours, it covered surprising breadth, as more than 170 different cases were presented. The handout accompanying this talk was excellent and served as a condensed review of all the material she covered.

Any resident attending an AAD meeting should first review the schedule carefully and then find topics that would be most beneficial during training and later on during practice. The recommendations I have made summarize material that will benefit all trainees in dermatology. Even those of us who will be continuing on to a fellowship need to have a handle on these topics to remain current and better communicate with colleagues. I look forward to seeing you all at future meetings!

We want to know your views! Tell us what you think.

With the annual meeting of the American Academy of Dermatology (AAD) set in the “mile-high city” now behind us, we must begin to convert didactic sessions into improved outcomes in our daily patient encounters. The enormous variety of lectures and frequently overlapping schedules can make this event a whirlwind for unseasoned attendees. I aim to enlighten those attending future meetings about individual sessions of particularly high value to the dermatologist in training. As a disclaimer, my primary interests are in medical dermatology, so the content of the courses I recommend is by no means comprehensive; however, residents need to have a solid fund of medical knowledge to function in any practice setting and, perhaps more importantly, to pass the boards examination!

I think the session that takes the cake for utility and value for residents is “High Yield ‘Power Hour’ for Residents,” which was led by a group of education-oriented Harvard University dermatologists. The power “hour” in fact lasted 2 hours, during which there was a variety of material presented covering pediatric dermatology, allergic dermatitis, infectious disease dermatology, blistering disorders, and pharmacology. The presenters showed incredible enthusiasm for their respective topics, and their passion also was evident in the high-yield handouts that they provided that were jam-packed with tables, bullet points, and frequently tested material. I would recommend that attendees save or print the handouts and avoid taking extensive notes on them during the session. Sit back, relax, and just soak in the lectures; later on, review the handouts. Also, be sure to arrive early—this session fills up fast—and fill out your evaluation! These lecturers deserve credit for their presentations and deserve a much larger room to accommodate residents that are otherwise willing to sit on the floor, crowd against the walls, and peek in through the doorway to listen.

I also feel residents benefit from lectures that provide us with practical information regarding complicated medical problems. I greatly enjoyed the symposium “Biologics: Perils and Promise” led by Canadian Dermatology Association President Richard Langley, MD. This conglomerate of experts addressed the risk for infection and malignancy with the use of biologics as well as pediatric use. The symposium also touched on the cardiovascular risk inherent in psoriasis and new developments suggesting that the treatment of psoriasis decreases overall systemic inflammation and possibly even cardiovascular risk. Another symposium in the same vein was “Systemic Therapies for Dermatologists: A Comprehensive Review and Update,” which was divided into short lectures discussing agents from acitretin to Zelboraf (vemurafenib). Expert insight on the use of these drugs was invaluable for those of us who train in programs where we are not frequently exposed to these agents.

For those residents interested in an overview of dermatopathology, “Dermatopathology Made Simple” led by Christine Ko, MD, was a lightning-fast tour through the subject. Dr. Ko categorized diagnoses based on pattern and also compared similar pathology side-by-side, focusing on key differences to help cinch the correct diagnosis. Although this talk was only 2 hours, it covered surprising breadth, as more than 170 different cases were presented. The handout accompanying this talk was excellent and served as a condensed review of all the material she covered.

Any resident attending an AAD meeting should first review the schedule carefully and then find topics that would be most beneficial during training and later on during practice. The recommendations I have made summarize material that will benefit all trainees in dermatology. Even those of us who will be continuing on to a fellowship need to have a handle on these topics to remain current and better communicate with colleagues. I look forward to seeing you all at future meetings!

We want to know your views! Tell us what you think.

With the annual meeting of the American Academy of Dermatology (AAD) set in the “mile-high city” now behind us, we must begin to convert didactic sessions into improved outcomes in our daily patient encounters. The enormous variety of lectures and frequently overlapping schedules can make this event a whirlwind for unseasoned attendees. I aim to enlighten those attending future meetings about individual sessions of particularly high value to the dermatologist in training. As a disclaimer, my primary interests are in medical dermatology, so the content of the courses I recommend is by no means comprehensive; however, residents need to have a solid fund of medical knowledge to function in any practice setting and, perhaps more importantly, to pass the boards examination!

I think the session that takes the cake for utility and value for residents is “High Yield ‘Power Hour’ for Residents,” which was led by a group of education-oriented Harvard University dermatologists. The power “hour” in fact lasted 2 hours, during which there was a variety of material presented covering pediatric dermatology, allergic dermatitis, infectious disease dermatology, blistering disorders, and pharmacology. The presenters showed incredible enthusiasm for their respective topics, and their passion also was evident in the high-yield handouts that they provided that were jam-packed with tables, bullet points, and frequently tested material. I would recommend that attendees save or print the handouts and avoid taking extensive notes on them during the session. Sit back, relax, and just soak in the lectures; later on, review the handouts. Also, be sure to arrive early—this session fills up fast—and fill out your evaluation! These lecturers deserve credit for their presentations and deserve a much larger room to accommodate residents that are otherwise willing to sit on the floor, crowd against the walls, and peek in through the doorway to listen.

I also feel residents benefit from lectures that provide us with practical information regarding complicated medical problems. I greatly enjoyed the symposium “Biologics: Perils and Promise” led by Canadian Dermatology Association President Richard Langley, MD. This conglomerate of experts addressed the risk for infection and malignancy with the use of biologics as well as pediatric use. The symposium also touched on the cardiovascular risk inherent in psoriasis and new developments suggesting that the treatment of psoriasis decreases overall systemic inflammation and possibly even cardiovascular risk. Another symposium in the same vein was “Systemic Therapies for Dermatologists: A Comprehensive Review and Update,” which was divided into short lectures discussing agents from acitretin to Zelboraf (vemurafenib). Expert insight on the use of these drugs was invaluable for those of us who train in programs where we are not frequently exposed to these agents.

For those residents interested in an overview of dermatopathology, “Dermatopathology Made Simple” led by Christine Ko, MD, was a lightning-fast tour through the subject. Dr. Ko categorized diagnoses based on pattern and also compared similar pathology side-by-side, focusing on key differences to help cinch the correct diagnosis. Although this talk was only 2 hours, it covered surprising breadth, as more than 170 different cases were presented. The handout accompanying this talk was excellent and served as a condensed review of all the material she covered.

Any resident attending an AAD meeting should first review the schedule carefully and then find topics that would be most beneficial during training and later on during practice. The recommendations I have made summarize material that will benefit all trainees in dermatology. Even those of us who will be continuing on to a fellowship need to have a handle on these topics to remain current and better communicate with colleagues. I look forward to seeing you all at future meetings!

We want to know your views! Tell us what you think.

Historically and recently, leaders within psychiatry have expressed disdain over the public’s misunderstanding of the specialty.¹ There are many factors—cultural and sociopolitical influences, for example—that contribute to a generalized suspicion of the intent and the abilities of psychiatry. Few observers, however, have focused on how a lack of cohesion within the discipline might be an important, underappreciated influence in the misconceptions and mistrust.

One way to view the recent publication of the DSM-5 is as further positive application of evidence-based medicine and an indicator of the flexible, progressive adaptability of psychiatry. Indeed, Gawande has demonstrated the benefit of implementing a high degree of standardization in terms of maximizing economic efficiency and minimizing medical error.²

Yet critics of psychiatry use the DSM-5 to substantiate their claim that the field is still murky and unsure of itself. Major changes in classification and diagnostic criteria might support a Szaszian fallacy that we somehow create mental illness and simply fit individuals into the framework at our whim. In the midst of what is, at best, lateral movement in psychiatry, the extremism of critics of the specialty, such as Peter Breggin, might gain undeserved credence. Furthermore, the merits of these critics’ arguments remain largely unchallenged in the public arena.

It is worth noting 2 additional factors within psychiatry that contribute to its stagnation:

• Knowledge and practice are grossly misaligned. What practitioners know and what they do are quite different, and the best way to treat mental illness often takes a back seat to tradition or convenience. Consider neuroimaging, which has illustrated structural and functional changes in the brain that have contributed to the phenomenology of schizophrenia. Schizophrenia is considered a clinical diagnosis, but the value of imaging in predicting prognosis, progression, response to treatment, etc. is well known. Yet neuroimaging is underutilized and the cost-benefit analysis of this modality remains unexplored. Likewise, cognitive testing, an important tool in the diagnosis and prognosis of schizophrenia, is not standard practice. These are good reasons why psychiatry shouldn’t shy from the push toward medicalization: Incorporating imaging and genetic analysis into practice will go a long way toward building legitimacy.
• Mental illness is stigmatized within. The stigma of mental illness that psychiatry must overcome is rooted in ignorance and misunderstanding. However, psychiatry itself has done little to eliminate the stigma of mental illness among its practitioners. This is apparent in the punitive, non-progressive nature of most state programs for impaired physicians.³ This type of “individual discrimination” described by Carl Hart⁴ undoubtedly permeates the residency match and ranking process, even in psychiatry. How can any headway be made in curbing societal intolerance of, say, addiction when it thrives in the academic environment? 

A marriage that will dispel ignorance

In light of the continued undervaluation and ignorance of psychiatry, we can start by heeding the Buddhist teaching that change must come from within. To undertake change means to consolidate information and begin to change the inner workings, practices, and structure of the field itself. It means taking seriously the Research Domain Criteria outlined by Thomas Insel, MD, Director of the National Institute of Mental Health.⁵

 It is increasingly apparent that psychiatry and neurology are inseparable.⁶ Why is there still reluctance to collaborate between the specialties? Why are these 2 fields’ research efforts still relatively distinct from one another, and not being built upon what is already known?

Based on current knowledge, sophisticated proponents of neuropsychiatry aren’t being unreasonable in their desire to push for an elevated status. If the field is to move in the most constructive direction, we should encourage a marriage—a fusion—of psychiatry and neurology. We shouldn’t be satisfied with connecting the specialties in theory and discussion; we should seek a structural unison of departments, journals, teaching, texts, research efforts, and fellowship options and accreditations.

Disclosure
Dr. Siragusa reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

Historically and recently, leaders within psychiatry have expressed disdain over the public’s misunderstanding of the specialty.¹ There are many factors—cultural and sociopolitical influences, for example—that contribute to a generalized suspicion of the intent and the abilities of psychiatry. Few observers, however, have focused on how a lack of cohesion within the discipline might be an important, underappreciated influence in the misconceptions and mistrust.

One way to view the recent publication of the DSM-5 is as further positive application of evidence-based medicine and an indicator of the flexible, progressive adaptability of psychiatry. Indeed, Gawande has demonstrated the benefit of implementing a high degree of standardization in terms of maximizing economic efficiency and minimizing medical error.²

Yet critics of psychiatry use the DSM-5 to substantiate their claim that the field is still murky and unsure of itself. Major changes in classification and diagnostic criteria might support a Szaszian fallacy that we somehow create mental illness and simply fit individuals into the framework at our whim. In the midst of what is, at best, lateral movement in psychiatry, the extremism of critics of the specialty, such as Peter Breggin, might gain undeserved credence. Furthermore, the merits of these critics’ arguments remain largely unchallenged in the public arena.

It is worth noting 2 additional factors within psychiatry that contribute to its stagnation:

• Knowledge and practice are grossly misaligned. What practitioners know and what they do are quite different, and the best way to treat mental illness often takes a back seat to tradition or convenience. Consider neuroimaging, which has illustrated structural and functional changes in the brain that have contributed to the phenomenology of schizophrenia. Schizophrenia is considered a clinical diagnosis, but the value of imaging in predicting prognosis, progression, response to treatment, etc. is well known. Yet neuroimaging is underutilized and the cost-benefit analysis of this modality remains unexplored. Likewise, cognitive testing, an important tool in the diagnosis and prognosis of schizophrenia, is not standard practice. These are good reasons why psychiatry shouldn’t shy from the push toward medicalization: Incorporating imaging and genetic analysis into practice will go a long way toward building legitimacy.
• Mental illness is stigmatized within. The stigma of mental illness that psychiatry must overcome is rooted in ignorance and misunderstanding. However, psychiatry itself has done little to eliminate the stigma of mental illness among its practitioners. This is apparent in the punitive, non-progressive nature of most state programs for impaired physicians.³ This type of “individual discrimination” described by Carl Hart⁴ undoubtedly permeates the residency match and ranking process, even in psychiatry. How can any headway be made in curbing societal intolerance of, say, addiction when it thrives in the academic environment? 

A marriage that will dispel ignorance

In light of the continued undervaluation and ignorance of psychiatry, we can start by heeding the Buddhist teaching that change must come from within. To undertake change means to consolidate information and begin to change the inner workings, practices, and structure of the field itself. It means taking seriously the Research Domain Criteria outlined by Thomas Insel, MD, Director of the National Institute of Mental Health.⁵

 It is increasingly apparent that psychiatry and neurology are inseparable.⁶ Why is there still reluctance to collaborate between the specialties? Why are these 2 fields’ research efforts still relatively distinct from one another, and not being built upon what is already known?

Based on current knowledge, sophisticated proponents of neuropsychiatry aren’t being unreasonable in their desire to push for an elevated status. If the field is to move in the most constructive direction, we should encourage a marriage—a fusion—of psychiatry and neurology. We shouldn’t be satisfied with connecting the specialties in theory and discussion; we should seek a structural unison of departments, journals, teaching, texts, research efforts, and fellowship options and accreditations.

Disclosure
Dr. Siragusa reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

Historically and recently, leaders within psychiatry have expressed disdain over the public’s misunderstanding of the specialty.¹ There are many factors—cultural and sociopolitical influences, for example—that contribute to a generalized suspicion of the intent and the abilities of psychiatry. Few observers, however, have focused on how a lack of cohesion within the discipline might be an important, underappreciated influence in the misconceptions and mistrust.

One way to view the recent publication of the DSM-5 is as further positive application of evidence-based medicine and an indicator of the flexible, progressive adaptability of psychiatry. Indeed, Gawande has demonstrated the benefit of implementing a high degree of standardization in terms of maximizing economic efficiency and minimizing medical error.²

Yet critics of psychiatry use the DSM-5 to substantiate their claim that the field is still murky and unsure of itself. Major changes in classification and diagnostic criteria might support a Szaszian fallacy that we somehow create mental illness and simply fit individuals into the framework at our whim. In the midst of what is, at best, lateral movement in psychiatry, the extremism of critics of the specialty, such as Peter Breggin, might gain undeserved credence. Furthermore, the merits of these critics’ arguments remain largely unchallenged in the public arena.

It is worth noting 2 additional factors within psychiatry that contribute to its stagnation:

• Knowledge and practice are grossly misaligned. What practitioners know and what they do are quite different, and the best way to treat mental illness often takes a back seat to tradition or convenience. Consider neuroimaging, which has illustrated structural and functional changes in the brain that have contributed to the phenomenology of schizophrenia. Schizophrenia is considered a clinical diagnosis, but the value of imaging in predicting prognosis, progression, response to treatment, etc. is well known. Yet neuroimaging is underutilized and the cost-benefit analysis of this modality remains unexplored. Likewise, cognitive testing, an important tool in the diagnosis and prognosis of schizophrenia, is not standard practice. These are good reasons why psychiatry shouldn’t shy from the push toward medicalization: Incorporating imaging and genetic analysis into practice will go a long way toward building legitimacy.
• Mental illness is stigmatized within. The stigma of mental illness that psychiatry must overcome is rooted in ignorance and misunderstanding. However, psychiatry itself has done little to eliminate the stigma of mental illness among its practitioners. This is apparent in the punitive, non-progressive nature of most state programs for impaired physicians.³ This type of “individual discrimination” described by Carl Hart⁴ undoubtedly permeates the residency match and ranking process, even in psychiatry. How can any headway be made in curbing societal intolerance of, say, addiction when it thrives in the academic environment? 

A marriage that will dispel ignorance

In light of the continued undervaluation and ignorance of psychiatry, we can start by heeding the Buddhist teaching that change must come from within. To undertake change means to consolidate information and begin to change the inner workings, practices, and structure of the field itself. It means taking seriously the Research Domain Criteria outlined by Thomas Insel, MD, Director of the National Institute of Mental Health.⁵

 It is increasingly apparent that psychiatry and neurology are inseparable.⁶ Why is there still reluctance to collaborate between the specialties? Why are these 2 fields’ research efforts still relatively distinct from one another, and not being built upon what is already known?

Based on current knowledge, sophisticated proponents of neuropsychiatry aren’t being unreasonable in their desire to push for an elevated status. If the field is to move in the most constructive direction, we should encourage a marriage—a fusion—of psychiatry and neurology. We shouldn’t be satisfied with connecting the specialties in theory and discussion; we should seek a structural unison of departments, journals, teaching, texts, research efforts, and fellowship options and accreditations.

Disclosure
Dr. Siragusa reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.