Jane Gagliardi, MD has been a faculty member for both the division of general Internal medicine and the Department of Psychiatry and Behavioral Sciences for the past decade. In this week’s faculty spotlight, Gagliardi talks to us about how her training in both areas informs her practice, teaching evidence based medicine, and being a competitive lap swimmer.
How long have you been at Duke? How long have you been at the division? I have been at Duke since 1994, when I came to medical school. I stayed for my 5-year combined residency in internal medicine and psychiatry and have been on faculty in both departments since 2003. My primary appointment is in the Department of Psychiatry and Behavioral Sciences, and I have a secondary appointment in the Department of Medicine, Division of General Medicine.
What are your responsibilities within the division? What does a typical day for you look like?
Up until July 1, 2014, I served as the Director of Undergraduate Medical Education in the Department of Medicine. I have transitioned out of that role, but I continue to round at Duke University Hospital on the academic General Medicine service. I’m involved in the task force, working on safe prescription of opioid medications in Duke University Health System. Outside of my clinical medicine responsibilities, I belong to the "Psychiatry Hospitalist" group. I round on the combined Medicine-Psychiatry service, the Williams Inpatient Psychiatry Service, and provide psychiatric consultative services at Duke Raleigh Hospital.
From an educational and administrative perspective, I am now the residency training director for the Psychiatry residency training program, and I am the Vice Chair for Education in the Department of Psychiatry and Behavioral Sciences. I co-direct the Evidence-Based Medicine elective for Duke medical students and participate on hospital and health system committees focusing on education, patient safety and medication safety. Given variety of activities I have cobbled together, it is difficult to say what a "typical" day would look like, but my work typically includes an interesting variety of interactions with individual students, trainees, patients and physicians in settings ranging from meetings to conferences to educational sessions to patient care rooms.
On a typical day, I may be spotted running (or walking very quickly, depending on how late I am) back and forth between obligations and commitments at the Civitan Building, Duke University Hospital, the Trent-Semans Center for Health Education, and the Duke Clinics.
One of your major interests is the overlap between internal medicine and psychiatry. How do your backgrounds in these two areas inform each other?
I heard the following quote from American Psychiatric Association President Dr. Paul Summergrad: "Our patients come to us integrated...it's our healthcare system that is not." In my view, taking care of a patient is best accomplished by recognizing factors that may be artificially delineated as "medical" or "psychiatric" but which coexist and interact to produce a human being experiencing illness or distress.
I think my psychiatric training helps me to bring a well-rounded perspective to my patients and their care. Even as an intern on the cardiology service, I remember being interested in the story of the individuals I would be admitting. Rather than distilling a history down to symptoms of acute coronary syndrome, I was interested in hearing about what was going on in that person's life at the moment when he or she first noticed the crushing substernal chest pain.
Even now, I will find myself spending extra time trying to learn about my patients' stories, because that's what I find most interesting. I also find that my experiences with patients in extreme psychiatric and social situations helps me keep perspective on "difficult" interactions or clinical decision-making. On the flip side, I believe my medical training has helped me to develop and hone my critical thinking skills. From critical appraisal of best evidence to critical thinking of the "cadillac workup for unexplained abdominal pain and the dwindles" that somehow managed to omit a morning cortisol level, I think critically about the symptoms my patients present and how they might (or might not!) fit into a psychiatric diagnostic category and whether further evaluation might be warranted.
I also believe that psychiatrists need to be more fully integrated into the healthcare team; being able to "speak the language" of primary care providers and internists can be very helpful in this regard. It also helps to be able to treat routine / basic medical problems.
You also co-designed an interactive class to teach evidence-based medicine to third- and fourth-year medical students. How did you design this course? Is it still being offered?
The course was approved in 2005 and began its run in 2006. It has evolved over time and now is well-established as a 6-session seminar course designed to teach students how to optimally use the best evidence in the care of their patients. Right now we are gearing up for our 10th season; the course will take place mid-January through February.
Course co-director Megan von Isenburg and I are fortunate to have the enthusiastic and expert participation of a variety of faculty members, including General Internal Medicine division members Daniella Zipkin and Larry Greenblatt and Department of Medicine faculty members Schuyler Jones, Manesh Patel and Cathleen Colon-Emeric.
What passions or hobbies do you have outside of the division?
Outside of the division (but still within work) I have a lot of passions. I am passionate about patient safety, education, and various initiatives and projects related to these themes, with an emphasis on residency education in psychiatry.
Outside of work, my passion is my family: my husband and two sons, ages 6 1/2 and 8. Many of my outside-of-work activities revolve around the kids -- watching soccer, encouraging good taekwondo form, enforcing regular piano practice, watching them become fanatically interested in Minecraft, and debating with my husband the merits and optimal timing of introducing Star Wars into their conscious experience.
As a former college swimmer and a sometime-marathoner, I am committed to running or swimming and try to run or swim every day. I could be accurately described as a "competitive lap swimmer" at this point. I returned from a AAMC mid-career women's professional development seminar with a goal of starting to practice Yoga, which I am trying to do on a weekly basis.