Preparing for the Next Stage

Abstract

As I have gotten older, my career has taken several twists and turns. Each turn has brought new colleagues and new opportunities to learn. During my “peak” years, I had a 30-hour outpatient practice of adult psychiatry, informed by the cognitive therapy model that I learned from Aaron Beck, MD. When I left Washington, DC, for Charleston, South Carolina, I took an academic job. I taught the cognitive model and supervised psychiatric resident psychotherapy, worked for the first time in an adult primary care clinic, and worked alongside an oncologist, seeing his patients once a week with him. During this 3-year oncology outpatient experience, the value of the cognitive model for helping cancer patients adjust to their disease became apparent. I left the university in 2003. For the next 7 years, I had a small private practice, did some speaking, and worked in an outpatient oncology practice for 18 months. In 2010, I was hired by the Department of Medicine of the Veterans Administration hospital to work part-time on a palliative care geriatric team. I continued my private office time, but at a reduced level. It was at the Veterans Administration hospital, when I applied the cognitive model to newly admitted nursing home veterans, that I found the most use for the concept of life stage. Elderly male patients admitted to a nursing home unit on an “end-of-life contract” often lived longer and did better than expected. There was an often unanticipated need for them to focus on this life stage to determine their plan for it. I worked with several men (and a few female veterans) to help them do this. I did not expect this life stage work, however, to be relevant to my office practice, which represented a more heterogeneous group of patients. Then, one day, an internist colleague referred Mr A to me for cognitive therapy.