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Featured Interview: Psychiatrist Dr. Kathleen A. Erwin, M.D., Ph.D

Dr. Erwin

We are excited to introduce to you another local medical professional who we have the pleasure to work with.  Dr. Kathleen Erwin is more than just a psychiatrist, she shares the same level of passion for helping others and enthusiasm for advocacy that we do at Grace Care Management.  Her warm and friendly personality is apparent from the moment you walk into her office doors.  In our interview, Dr. Erwin shares some of her work with us and also what her view is on the current health care system.  We hope you enjoy our feature just as much as we enjoyed sitting down with her!

Dr. Erwin received her medical degree from U.C. San Diego, and went on to complete her Psychiatry residency there. She specializes in consultation / liaison (hospital) psychiatry, as well as bipolar disorder and maternal mental health.  When she is not seeing inpatients at Scripps Memorial Hospital Encinitas, or outpatients in her private office nearby, she enjoys hiking, running, skiing, and listening to music.  Here is her featured interview!

Can you describe to us your relationship with Scripps and how that works into your private practice?

I am currently on the medical staff at Scripps Memorial Hospital in Encinitas, but am not an employee. I see patients in consultation but I don’t admit or discharge them. At the hospital I see patients in the intensive care unit, medical surgical units, acute rehab unit, and the labor and delivery unit. I work with a variety of patients who come into Scripps already diagnosed with a psychiatric illnesses, and also patients where it’s not clear whether they have a psychiatric illness and I’m called in to evaluate that.

I often get called on patients whose behavior is a problem. It is my job to evaluate if it is because they are in pain, are delirious, are having medication side effects, have been misdiagnosed and are not being medicated properly, or if maybe they are even going through alcohol withdrawal. I perform many different types of consults and work with all kinds of patients. For example, just today I saw two different patients in the acute rehab unit with very different reasons for their brain injury, but both had very similar symptoms. I also evaluate patients for safety reasons that have ended up in the intensive care unit.

I work at the hospital about half time and am called in by the hospitalists, cardiologists, neurologists and other specialists. I work the other half time in my own private practice office in Encinitas. It’s a nice combination because I never get bored!

What approach do you take with your patients that may be different from other psychiatrists?

Partly, it’s that I have more of a neuropsychiatric background, so am still very much involved in the medical angle. I don’t wear a stethoscope everyday, but I remember things about lab values, infectious conditions and neurologic puzzles that your average psychiatrist might no longer be interacting with. I collaborate with all the different kinds of doctors at the hospital, so I am constantly learning about new medications for cardiac conditions, diabetes management and that sort of thing. Most psychiatrists aren’t involved in that.

In the outpatient arena, this helps me step back and look at the big picture. I have to question if everything I’m seeing is being driven by their psychiatric illness, since the patient may have other things going on that are contributing to their symptoms. I’m really enjoying keeping up my skills in that area.  I also do psychotherapy, which many psychiatrists do not. Those are really the primary things that make me different from other psychiatrists.

What role do you think psychiatrists should play in the overall health care system?

A lot more than they are playing right now, that is for sure! There is an issue of parity in mental health care, meaning psychiatric conditions are supposed to be treated no differently than other general medical conditions. Unfortunately, often this is not the case. The idea is that historically insurance companies put limits on the number of visits accepted, different co-pays, deductibles etc… but the idea is that conditions are treated very differently and they shouldn’t be. The treatment plan for every patient should include psychosocial support and making sure their mental health is intact with proper treatments. In addition, there is a shortage of psychiatrists and beds available for psych patients, along with too little outpatient follow-up. This crisis is getting worse and worse.

When working with a patient with previous history of brain injury or stroke, what do you see as the greatest key to success in their recovery?

Assuring them that they are going to get better. I don’t try and promise things I cannot be sure of, but I always let my patients know, especially in the earlier stages, they will make progress and I have seen their illness before. I encourage them that although it might not be the outcome they were hoping for, that it does get better with continuing treatment. The single most important treatment I can give as a physician is hope. I can give them specific positive examples of others I have worked with, who had a similar diagnosis and made huge progress. With many of my patients, you would never have even known they were the same person, the progress was so significant. This always brings a new patient the hope and comfort that they need to hear!

As care managers, we are always interested in feedback from the doctors we work with on how we help benefit their practice. How do you see care management as beneficial to your patients?

Two things come to mind as most important. With a care manager helping my patient, I get the important data I need to guide my treatment plan. I need to know how they are sleeping, any side effects to medications, or behavioral changes. Often patients don’t remember what is going on with their mental state and I’m not given the correct information when we meet. I can’t just send them to the lab to get all of the data I need, so having a care manager is very valuable. The second thing is that often it allows me to work with the family and patient to keep them at the level of care that they are at. Whether that is at home or in a facility, it is hugely important. This is particularly imperative for dementia patients, as changing an environment makes them extremely vulnerable to increased confusion and agony. They don’t want to lose all of their independence and having to change their home environment can be very upsetting.

Many times my patients don’t have family that is able to help, due to distance or time barriers, so having a good caregiving and care management team is important.   It can also save the system money in the long run, and allows the family to feel that they are able to help give their loved one quality care.

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