Oldham Stresses Importance of Integrated Care

To incoming APA President John Oldham, M.D., "Integrated Care"—the theme of his presidential year—is no empty catch phrase.

"To me, integrated care has many important meanings—integrating work with the rest of medicine, integrating education and teaching and the latest research findings into our clinical work, and integrating the stages of a patient's treatment into a coherent, progressive plan," he said at the Opening Session of this year's annual meeting in Honolulu last month.

Oldham outlined four priorities that he said will guide his presidential year: integration of psychiatry with the rest of medicine, the right of patients to quality treatment, the unacceptability of fragmented care, and the importance of research and education (see New APA President's Four Focus Areas). He related a remarkable clinical vignette to remind psychiatrists of the timeless importance of seeing "the person behind the disorder," a person who can be a partner in integrated treatment.

As an example, Oldham noted that he had recently received an e-mail from a patient ("Mr. R") whom Oldham had treated when he was a resident at Columbia. In the e-mail, Mr. R—who had been 22 years old and a student at the time of his illness—told Oldham that "he had done OK in life, which he thought would surprise me."

Oldham added, "He remembered me as arrogant, distant, pessimistic about his future, and not very helpful. I was stunned, since he was one of those patients we can all recall from our training years who had made a profound impression on me and was indelibly fixed in my memory."

Mr. R, an Orthodox Jew, had fallen in love with a woman outside of the Jewish faith, and his father had told him that if he married her, it would be "the death of him." But the young man persisted in his love and married her—and on the wedding day, the father died of a heart attack.

"I first met Mr. R shortly thereafter, when he was hospitalized in an acute psychotic state," Oldham recalled. "What I remember from those days was how concerned I was for Mr. R—I was, after all, a student too at the time. I didn't know enough yet to appreciate the power of human resilience and the recovery potential within us all. What Mr. R saw as coldness or arrogance was, in hindsight, a defensive formality that I needed to hide my anxiety and uncertainty about how I could help him. What I also had trouble seeing at the time was the person behind the psychosis, though he was there watching me and wanting to connect with me all the time."

After mulling over Mr. R's recent e-mail, Oldham decided to respond. "I told him that his message was valuable to me. I apologized for having been so unavailable to him, and I wished him well. A few days later he e-mailed me again saying how pleased he was that I had replied, and not to worry, that ‘all was forgiven.’ I haven't heard from him since.

"I think it conveys important messages for us all, reminding us of the power of hope, the potential for recovery, and that we must never lose sight of the whole person, who, for the time being, is not only our patient but also our partner in the treatment enterprise."