Michael J. Vergare, MD
Professor & Chair,
Department of Psychiatry
& Human Behavior
Consultation-Liaison General Service:
Thomas Jefferson University Hospital is a large academic teaching hospital established in 1825 and located in the center of Philadelphia. Jefferson has 969 beds and includes a wide range of clinical subspecialties. The clinical population is made up of a diverse ethnic, socio-economic, and cultural mix. The Psychiatry Consultation Service is consulted by all services, including internal medicine, family medicine, cardiology, oncology, pediatrics, neurosurgery, surgery, obstetrics and gynecology, and rehabilitation. Patients have varied psychiatric diagnoses: delirium, dementia, schizophrenia, substance abuse, mood disorders, anxiety disorders, personality disorders, adjustment disorders, post-traumatic stress disorders, somatoform disorders, and disorders due to general medical conditions. The Consult Service sees patients with complex medical and psychiatric conditions, and trains fellows, residents, and medical students how to care for these patients, collaborating care with the primary medical services.
Formal teaching rounds are led by Psychosomatic Medicine faculty. The Psychosomatic Medicine Fellow, PGY-2 psychiatry residents, and Jefferson medical students attend rounds. Fellows discuss treatment with the attending during case presentations on formal teaching rounds. The Fellow is in charge of conducting follow-up teaching on patients on the service. Fellows also take an active role in teaching and supervision of the PGY2 residents and medical students rotating through the Consultation-Liaison services.
In addition to General Hospital Consultations, Fellows also participate in:
Outpatient Mood Disorders Clinic: The Mood Disorders Program in the Department of Psychiatry at Thomas Jefferson University is an outpatient clinical and research program. The Fellows work directly with an attending for half a day each week, throughout the academic year, evaluating and following up with patients with mood disorders and/or significant medical comorbidities. Following patient visits, the Fellow meets with the attending to discuss the cases.
Sleep Medicine: For three months, the Fellow will participate in the Sleep Disorders Center for a half day each week. The Center is a clinical, research, and education program. Its clinical focus is the evaluation and management of patients suffering from a wide variety of sleep-related disorders. Treatment modalities include, continuous positive airway pressure (CPAP), pharmacological agents, oral applications, surgery (most commonly laser-assisted uvuloplasty and somnoplasty), biofeedback, hypnosis, stimulus control therapy, chronotherapy, sleep hygiene management, CBT, phototherapy, and sleep restriction, among others. The Fellow will assess patients with sleep disorders, and present them to Sleep Medicine attendings, discussing differential diagnosis and treatment.
Pain Medicine: The outpatient Pain Medicine Program is a three-month rotation, one half day each week. The Fellow will assess patients with chronic cancer and non-cancer pain syndromes and will discuss them with a pain specialist MD, to arrive at a differential diagnosis, treatment plan, and to manage follow-up care. Fellows will learn to perform a pain-focused physical examination and are trained in the use of pain assessment tools, case formulation, and treatment planning. We collaborate with psychiatry, anesthesia, neurology, rehabilitation, neurosurgery, physical therapy, and psychology practices throughout the tri-state region. Fellows learn the use of psychotropic medications, narcotics, and adjuvant analgesics in the pharmacologic management of chronic pain. Additionally, one will gain familiarity with a variety of nonpharmacologic modalities (hypnosis, psychotherapy, acupuncture, acupressure, surgery, biofeedback, etc), their indications, and relative utility in pain management.
Electives: Liaison electives include Geriatric Medicine and Palliative Care, Child Psychiatry Consultations, Sports Medicine, Addictions, Neurosurgery, Obstetrics/Gynecology, Oncology, Sickle Cell/Hematology, and Transplantation. The Fellow attends clinical, research, and educational activities in his/her chosen area of interest. The Fellow will be assigned supervisory or primary responsibility for all psychiatric consultations in the chosen area of interest on the general consultation service.
Michael J. Vergare, MD
Mitchell J. Cohen, MD
Vice Chair for Psychiatric Education
Madeleine Becker, MD
Program Director, Psychosomatic Medicine Fellowship
1020 Sansom Street
Philadelphia, PA 19107