PSYCHIATRY CONTINUITY SERVICES
"Time and tide waits for no one."
- Dr. Bhagwan Bahroo
The First 10-Minutes
Welcome to Psychiatry Continuity Services(otherwise known as PCS) at Walter Reed National Military Medical Center! This webpage is designed to introduce to you the treatment program, as well as provide a smooth transition to your first week.
You have to be in your chair, in uniform, carrying a smile by 0700h.
Go to building 85T, found in front of America Building.
Enter the two double doors and immediately turn left to go up the elevators. As soon as you step out, there will a door to the far left corner.
Passcode to said door is 1-2-3-4-5-6-7-8 (easy right?).
As soon as you enter, make your first right, then first left, then first right into a set of four cubicles.
How do the gears turn?
There two teams: Team A and Team B. Dr. Tim Heilmann is the current Service Chief. Every pt is AD. Each team has a prescriber, and 2-3 one-to-one therapists that have individual sessions with the patients throughout the week. Know what team you're on. Your role on the team will primarily be an extension of your prescriber with therapy and medication management. Patient will primarily go to their intensive group therapy in the mornings (most important part of their day) and then Recovery Skills Training in the afternoon.
There are three programs:
Trauma Recovery Program (TRP) for combat associated trauma (interruptible)
Interpersonal Recovery Program (IRP) for sexual assault and Military Sexual Trauma
Comprehensive Recovery Program (CRP) for all others.
Therapy and Med ManagemenT (TMM)
The first meeting of the week.
Done once a week usually earlier in the week, this is your time to shine as a psychiatrist. Patient can be pulled before they go to groups or if they are in CRP group. Therapy and medication management will be done with patients that have already been established. Purpose will be to review medications, need for refills, efficacy, tolerability, safety, and whether or not their weekend was of concern pertaining to their treatment. If the patient had an intake as the first part of their week, the second part of their week will be a Therapy and Medication Management (TMM).
Treatment Plan UpdatE (TPU)
Second meeting of the week.
A multi-disciplinary team meeting later in the week. Core providers include you, the staff attending, and their 1:1 therapist. Essentially similar to the therapy and medication management meeting, except, name it Treatment Plan Update (TPU). Again, if they had an intake earlier in the week, their second meeting in the week will be a TMM. If they are discharging that week, they will not need a TPU but rather a discharge summary, generally done on the day of discharge.
Day to day
I'm here.... now what?
You will have a meeting first thing at 0730h every day, currently being done virtually, and Team A has a longer session on Wednesdays. Ask for the link to these meetings your first day. Intakes and schedules for the week can be found in the PCS shared drive folder, under census. Expect generally 1-2 intakes, sometimes 3, ranging from Outpatient and Inpatient referrals. Plan your week around this. Intakes take a while. The notes will also take a while so ideally look up your patient prior or if doing a CSV, don't look them up. Once you are done seeing patients and writing notes for the day, you are free to go. Tuesdays at 1630 there is a journal club with Dr. Bahroo, Wednesdays are didactics, and Fridays you are only required to attend the 730 meeting and at 1200 there is a resident supervision session with Dr. Molchan, both currently being done virtually and you will need to ask for those links your first day.
AHLTA, where you really learn how to use it.
Get mapped to the PCS patient list on AHLTA. Call global and ask if they can map you to this specific clinic:
BFAB - PSYCH DAY HOSP BE
Everything will go in AHLTA (if not CHCS) for medication refills. Above you can find the templates for Intakes and specific lines to include in boxes for of your A/P and Disposition sections. Double click on "Handy Blurbs" - instructions are included above.