Friday, September 23, 2016

Canadian Psychiatric Association 66th Annual Conference

I am truly enjoying this Canadian Psychiatric Association conference.  The last conference I attended in Vancouver I so enjoyed Dr. Trevor Hurwitz presentation but then I always enjoy Dr. Hurwitz and hear him frequently at UBC.
19 years ago I joined the International Doctors in AA and have really enjoyed the psychiatrists  and psychiatric presentations there. That was mostly because of the spirituality.    I'm also connected with the Christian Medical and Dental Association and truly enjoy the psychiatrists I've befriended there. I’ve attended the World Congress of Psychiatry and International Society of Addiction Medicine and various other conferences where psychiatry and psychiatrists congregate but I really feel I might have enjoyed attending more CPA.
The CPA Journal did get a new editor, with the result it stopped being a publishing place for academic psychologists and began again to be relevant to me as a psychiatrist.  Reading the journal more is how I read the notice of this meeting.   I’ve been a member of CPA for decades and haven’t felt I got nearly as much bang for the buck as I get from the Christian Medical and Dental Society, until now.
This  CPA conference  is truly outstanding. I am beginning to think my issue with CPA might have less to do with transference and more to do with counter transference.  It’s like that time in therapy where your realize the therapist really might have something more to offer.  I hate to think this is solely my aging and increased wisdom.  I've wanted to attend this CPA since first I saw the line up of topics and speakers.  There are just so many excellent clinically relevant,  valuable and timely presentations.
Having to be at Kingston Hospital yesterday for a family meeting,  I missed that day, sorry to have not been present to hear Sidney Kennedy on Major Depression. I’d really wanted to do the advanced motivational interviewing course as motivational interviewing is something I do a lot of in my DTES clinical work.There was a new Canadian ECT Standards presentation and as I’ve referred several patients with intractable depression for ECT with good results (it’s been 25 years since I’ve given it myself,).  I really thought this was b important for me to review.  There were also some courses on use of social media which is extremely important and relevant. Given the mess the DSMV made of Somatic Symptom Disorder I had also looked forward to hearing this expertly addressed.
Today’s presentations made up for Thursdays academic loss. Being with family,  knowing love first hand and seeing the excellence of clinicians and a wonderful care team in action at Kingston made today’s presentations all the more poignant.
Today I was delighted to attend the ABC of DBT, Applying Principles to the Care of Patients with Substance Use Disorders.  Having treated a former professor of dialectics and discussed DBT extensively in therapy I’d studied it in journals,  on line and seen the excellent research findings of it’s benefits for the SUD populations.  Ketan Vegda, and Wiplove Lamba were truly awesome.  Their presentation alone was worth the price of admission.
I absolutely loved their role play.  It made sense of the theoretical material they had presented very well.  Watching and listening to the role play I felt  that I’ve  ‘got it’ in a way I’d not untill then. Next week in my clinic I’ll be applying simple variations on my well honed eclectic approach to therapy with patients.  Now that’s not something that I can say happens often given years of psychoanalytic psychotherapy training, group psychotherapy training, focal therapy training, CBT training starting in the 80’s, motivational therapy training, former hypnosis training, family therapy training and 12 step facilitation therapy training.  The fact is these young guys really know their stuff. It’s now obvious why and how DBT works and why patients with SUD would appreciate it.  I even went out and bought the recommended text, DBT Skills Training, Handouts and Worksheets by Marsham M. Linehan.  It’s not the same old same old repackaged thing.
I’m skeptical of advances in my field since so much of psychology is ‘renaming’ the old things. One young ‘person’ in the audience commented on the feelings of the therapist in relationship to the patient and how she appreciated the comments about this. I couldn’t resist later saying, “we used to refer to that as ‘counter transference’.  An older woman beside her laughed. It wasn’t against the young person but rather in amusing at the two of us being older and from a different era.   Not that that’s bad.
It was amusing later listening to books and names being bandied about by younger colleagues.  I hoped they still knew Freud, Jung, Karen Horney, Seligman, Kohut, Kernberg.  I did feel though that the ‘pop stars’ of today are a generation beyond my own pantheon. The classics obviously remain but not the lesser stars.   The field is just so broad too today.   It's like my days of Elvis, the Beatles and Rolling Stones.  I remember looking at the line up of a local rock festival and realizing I didn’t know a single entertainer.  I’m still listening to the Guess Who.
I loved the booths and papers and lounge area.  I spent literally  an hour on two separate occasions talking to medication representatives, military forces personnel,  treatment centre personnel, recruiters, banking and insurance folk and regional representatives.  I go to trade shows these days, mostly to do with motorcycles and boats.  But I like to look at what’s being offered and sometimes really enjoy chatting with the folk there.   I always love meeting the Edgewood folk.  Interior BC Health and BC recruiters were terrific.  I love learning that Ability,  a medication I use  extensively in tablet form has come out with Ability Maintena, a monthly injectable form.   I didn’t even know about Latuda (Lurasidone hydrochloride) which is apparently much more used in Eastern Canada. It’s real attraction for me as an antipsychotic was the lack of QT complications.  The Pristiq rep showed me that Pristiq had few side effects than high dose effexor and was well tolerated when used with other meds. I also met the folks from the Medical Psychotherapy Association of Canada.  Having talked with them and learned about MDPAC, I really think this is a group I need to belong to.
Everyone loved the keynote speaker, Clara Hughes, Open Heart, Open Mind. There was a line up forever of folks, who having bought her book were happily waiting for an autograph.
The book selection provided by two sellers was awesome. I tend to down load e books mostly these days reading everything on my Ipad but even so I came away with a Medical Clinics of North America Travel and Adventure Medicine.  I used to attend those conferences when I was more focussed on off shore sailing, having sailed solo to Hawaii in winter.  I loved the whacky doctors I there, no psychiatrists stick out except some fellow who liked the places ‘above where helicopters go’. We related to how our work caused us to enjoy time in extreme wilderness.
I mostly like conferences for networking. I  talked to several psychiatrists I liked instantly.  There was a real international flavour to the conference with every colour of skin and a multitude of accents represented.
The Royal College of Physicians and Surgeons had a terrific young man answering questions about MOCOMP. I love MOCOMP and Mainport our continuing medical education service. I bored the young man with my pet peeve but really otherwise love MOCOMP.  He was there to present on the new ‘competency’ approach to following careers.  Given that Mainport is an excellent reflection of my ongoing study which I like as a journal, I think the very smart and creative folk at RCPS are going to keep astounding us. Who knows, they may address my libertarian pet peeve.  The engineers have rebelled and done a masterful job of facing the gun toting political bullies. I don’t mind recording my study as a professional but am questioning ‘administrators’ arrogance with their self serving money driven  ‘educational accreditation’ processes.  I will probably ‘forget’ to fill in some form about this CPA conference and some supercilious shit will object that I didn’t get my ‘attendance’ cosigned in triplicate. I remember I lead an insurrection against the hospital management wanting clinicians to use a ‘time clock’.  I think this is something I discussed at length in my psychoanalytic therapy in training years.
Unfortunately the Transcultural Psychiatry workshop I’d wanted to attend overlapped with the Chronic Pain, PTSD and TBI workshop I really felt I needed to attend.  So much of my work is specifically trauma,head injury and pain related.  I’m often called upon to be an expert witness and sometimes actually undertake that role voluntarily.  Zohar Waisman MD FRCPC and Adam Little LLB were incredible!  They did a role play with discussion by themselves and incorporating the audience.  Zohar, “performed” as doctor expert witness and Adam as lawyer in a case which had actually occurred.  The audience discussion and the points made and the nitty gritty of expert witness/clinician was humorously and pertinently discussed.  I commented later that their presentation had been so ‘like’ the 'real thing’ I was having ‘flashbacks’ of my own worst moments in court.  What a great presentation! Well worth attending the conference for the learning in that session alone.
I am pissed that I missed Susan Abbey and George Jarvis.  I even missed Harry Kaplinsky!  The CPA Conference is as  bad as going to an ice cream counter and having to choose.  I get Cherry Ice Cream but must forgo the Pistachio and Green Tea flavours. It’s not fair!.
I was also highly responsible and chose Advances in Diagnosis Treatment and Prevention of Dementia, not just because I personally need to know how to prevent it, but mostly because I’m seeing more elderly patients in my practice. Having thoroughly enjoyed the presentations of Tarek Rajji, Zahinoor Ismaiel, Amer Burhan and Sanjeev Kumar I feel more confidence, recognized a couple of mistakes I’ve made which I can address next week without harm to patient,  but now I mostly know where to turn.  I really am going to change my practice for the better.   I have answers to questions I’d had put to me by patients and family which I’d not been able to answer. Now I can.  I really liked the humanity of these fellows too. Yes they were researchers and published internationally accredited papers but it was clear that they cared for people.
So that was the day.  Tomorrow I have a whole day more of really great psychiatry learning. They’re even going to feed me at a Thing called the President’s Gala. This Westin Harbour Castle Hotel in Toronto is really fine too.  I love my view of the Harbour. Now that my sailboat is in these fresh waters I can imagine one day anchoring somewhere out there. I see an island and wonder if it’s the same one where I was swimming as a teenager and participated in rescuing a drowning woman.  Toronto is a favourite city with so many memories for me. Another reason I was glad to come to CPA.  2017 the Conference is in Ottawa. As so many close family are there, I believe I’ll be attending the CPA again.  I’m really enjoying this conference.
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