Archive for the ‘Hershey Medical Center’ category

Personalize This

January 17th, 2013

The future of psychiatry, and indeed all of medicine, will emerge as we unravel the double helix of the genetic code, the proteins DNA commands, and the epigenetic factors that allow our environment to influence genetic expression. Today, I caught a brief glimpse of that future.

I just attended the ceremonial opening of the Penn State Hershey Institute for Personalized Medicine, one of a handful of high technology centers that will pave the way to a new era in health care. This multimillion dollar facility was enabled by federal, state, and private funds, and the inaugural event was attended by a U.S. senator and many United States, Pennsylvania, and university dignitaries. The Institute consists of laboratories that can quickly and relatively inexpensively map individual genomes, a tissue repository for samples from thousands of patients, and an information technology hub.

When I was a medical student in the 1960s, virtually all children with leukemia died. Today, almost all survive. The difference has been discoveries about the mysteries of individual cancers and how to target treatments to their unique signatures. Not only has survival increased, but when cancer treatments can be personalized, doctors can apply less toxic medicines than the systemic poisons we have used for decades.

I am committing significant discretionary funds from my department to leverage our new center’s technology to achieve breakthroughs in psychiatry. Instead of blasting every cell in the body with increased levels of serotonin, someday we should be able to target interventions to distinct pathophysiology underlying diseases of impulse, mood, and thought. As in other medical specialties, we will bank tissue samples from psychiatric patients, establish diagnoses, track symptoms systematically over time, record responses to treatments, and use computer programs to link biology to pathology and ultimately to cure. It is an exciting time.

-Alan J. Gelenberg, M.D.
Editor, Biological Therapies in Psychiatry
Shively/Tan Professor and Chair, Psychiatry, Penn State University
Editor-in-Chief, Journal of Clinical Psychiatry

Learning Psychiatry

October 18th, 2010

After four years of medical school, a student wishing to specialize in psychiatry enters our residency. My faculty and I then have four more years (five, if the trainee elects child psychiatry) to turn the physician into a psychiatrist.

Our goal is to produce clinicians who will be knowledgeable and compassionate with patients, to be doctors we’d refer our family members to. Above all, they should be safe practitioners. What do we hope the residents will learn in four years?

The mental status examination and standard observation and description are relatively static over time. Diagnostic categories evolve slowly.  Psychotherapies evolve, also relatively gradually.  But neurobiology progresses rapidly, and pharmacology and other biological interventions change constantly.

I am acutely aware that many practical pointers I give my residents (how many milligrams of that drug to prescribe) will be obsolete before they graduate. So, what do I really want them to carry away from their four postgraduate years at a university?

Lifelong learning: it’s not an abstraction but a vital requirement for all doctors. (I don’t want to see an internist whose knowledge is out of date.) I try to imbue my residents with that as a core value. And I hope to model for them an approach—to patients and to the application of constantly updated knowledge to their care. I try to demonstrate incisive but compassionate interviewing, thoughtful formulation, and up-to-date bio-psycho-social therapeutic interventions.

It isn’t easy. If it were, it wouldn’t be fun. And it is.

Why I am excited about partnerships

June 8th, 2010

I have spent my career trying to bring together various organizations and factions in a community that share a commitment to helping the mentally ill but don’t historically work together to accomplish that goal. A lot of money and effort is wasted when bureaucrats or community activists protect their fiefdoms at the expense of helping patients.

It’s hard to change that mentality, but well worth it.

When I began my career in Massachusetts, I worked at the Erich Lindemann Mental Health Center, a collaboration among the Commonwealth of Massachusetts, Harvard Medical School, and the Massachusetts General Hospital. Together we built systems of care, research, and education—all to serve people with mental illness.

Later when I moved to Arizona as head of the UA Medical School’s Department of Psychiatry, I reached out to the broader community to form coalitions. We were actually quite successful. We were able to create the Community Partnership of Southern Arizona. And eventually the University of Arizona and our physicians’ group practice partnered with Pima County to build and operate a brand-new psychiatric hospital.

Now that I’m in Pennsylvania, I am working with a wonderfully dedicated group to put strong legs under the fledgling Pennsylvania Psychiatric Institute. I talked a little about it in my last blog.

Partnerships must be the future of medicine in this country. There’s too little money and too great a need to put personal power-building ahead of real progress in medical care for people in serious need.

Public-Private-Academic Partnerships

June 1st, 2010

With the nation in the midst of the largest health reform since the advent of Medicare/Medicaid, we will undoubtedly see more public-private partnerships in the health care arena.

Let me tell you how a similar partnership is working for psychiatry in central Pennsylvania.

Two years ago, Penn State Hershey Medical Center (HMC) created a brand- new not-for-profit entity in partnership with Pinnacle Health, also a not-for-profit. Pennsylvania Psychiatric Institute (PPI), serves provides in-patient and out-patient services for patients in the Harrisburg area and across a large swath of central PA.

Of course there were hurdles. It’s never easy to get Medicare certification for a new organization, for example. But some hurdles were avoided by wise planning. For instance, PPI’s board is made up equally of Hershey Medical Center, Pinnacle Health, and community leaders. That balance is reflected in the balanced strategic planning and tactical interventions required of the organization.  (Full disclosure: I sit on the board). And another huge plus: both HMC and Pinnacle were willing to losing several million dollars during the initial phases of start-up, demonstrating a true commitment to the treatment of the mentally ill.

Is the Pennsylvania Psychiatric Institute out of the woods? Certainly not yet, and perhaps not as long as doctors and hospitals try to survive the age of slim reimbursement.  But so far, so good. It’s a very promising partnership, and one that may serve as a model for others. I, for one, am delighted to be part of the team, bringing teaching and research to a system that seeks to provide state-of-the-art care.

Moving to Penn State Hershey Medical College

May 24th, 2010

It’s a wonderful feeling to find your home. That’s what I feel now that I’ve arrive back in the state of my birth, back in a wonderful academic medical setting,  and back doing what I love.

I was asked to come to Penn State Hershey Medical Center under very sad circumstances. The chair of the Department of Psychiatry, Dr. James Hegarty, needed to take a medical leave, and very soon after my arrival died from a brain tumor, despite his valiant battle. I am profoundly moved to take over his duties as Interim Chair.

The Penn State Department of Psychiatry is a joy: Wonderful physicians, excellent research, a very promising partnership with a not-for-profit psychiatric system. For me, the most rewarding aspect is using all the skills I have acquired over my lifetime—as a clinician, as an administrator, and as a scientist.

I love writing Biological Therapies in Psychiatry, and I feel truly blessed to be able to continue that calling while adding the adventure and fulfillment of my “day job” at Penn State Hershey Medical Center.

For those of you who may wish to contact me, my new email address is agelenberg@psu.edu.