Barbara Ann Schindler, MD, FAPM, DLFAPA
Barbara A. Schindler, M.D., Professor of Psychiatry and Pediatrics graduated from the Woman’s Medical College of Pennsylvania in 1970 and served as a medical, then psychiatry, resident/child fellow and then faculty member in Drexel’s historic medical schools. She has served as an educational leader, clinician and researcher. Highlights include the establishment of a nationally recognized psychiatric consultation-liaison service, the creation of the Caring Together Program for women with substance use and psychiatric disorders, leadership as Interim Chair of Psychiatry for 2 years and leadership of the medical school’s Office of Educational Affairs as Vice Dean for 18 years. In her position as Vice Dean from 1996-2014, Dr. Schindler had responsibility for the admission and medical education of over 1050 medical students per year at multiple clinical campuses as well as continuing medical education (CME), providing necessary leadership thru the Allegheny bankruptcy and ensuring medical school accreditation through several Liaison Committee on Medical Education (LCME) site visits. In her Vice Dean role, she also created the Drexel Pathway to Medical School program and the Physician Refresher Course. She was elected as a professional member to the LCME for 6 years and has chaired accreditation site visits at over 25 US medical schools since 2002. She has been the PI of four SAMHSA grants that support the mission of Community Treatment Programs as well as ensuring annual financial support from Philadelphia’s Department of Behavioral Health. Dr. Schindler was co-PI on a National Institute on Drug Abuse (NIDA) grant to study the educational outcomes of an innovative online communications skills educational program developed for medical trainees which resulted in Drexel being designated by NIDA as a Center of Excellence for Physician Information. Dr. Schindler has over 150 publications, abstracts and presentations in consultation-liaison psychiatry, psychosomatic medicine, substance abuse in women and in medical education and numerous local and national awards for her contributions to medical education, leadership and scholarly work.
My Cobbled Road to a Career in Addiction Psychiatry
As a medical student, an adult, and child psychiatric resident/fellow, I had no specific aspiration or plan to practice addiction psychiatry. My many clinical experiences led me down a path that has been challenging, amazing and extremely gratifying despite many bumps in the road. As I reflect on those many formative experiences, a few things stand out. As a second-year psychiatric resident in the outpatient clinic in the early 1970’s, I was told by several psychotherapy supervisors to “not waste their time” presenting patients with a co-occurring substance use disorder (SUD) because “those patients are untreatable”. Those comments from faculty both stung but also prompted me to seek out a very supportive mentor, Dr. William O’Brien who would patiently review cases with me. As my long-standing interest in psychosomatic medicine led me to work in Consultation-Liaison psychiatry, I had the opportunity to see many patients in consultation admitted to the medical hospital and in the medical clinics with substance use disorders and to witness the negative ways our healthcare system and providers dealt with those very vulnerable patients. There were frequent “competency evaluation” requests for patients with subacute bacterial endocarditis secondary to IV opioid use who wanted to sign out against medical advice “AMA”. The real clinical issue was grossly inadequate management of the patients’ opioid withdrawal symptoms and not decisional capacity. It led to my first academic publication as we delineated the reasons that cohort of patients left “AMA”. The C-L service witnessed, when doing consults in the ED for patients in withdrawal, openly verbalized recommendations by the ED staff to “go home and drink” and “your symptoms will go away.” That further sparked my interest in how essential medical education was in addressing the paucity of knowledge in my medical colleagues on how to appropriately evaluate, manage and refer patients with SUD’s in the medical setting. At one point in the height of the last opioid epidemic, the hospital formulary committee voted to remove methadone from the formulary because “we don’t want those patients coming to our hospital”.This led to the creation for National Institute on Drug Abuse (NIDA), an online module to teach providers how to screen SUDs and an outcome study of its use in medical students and primary care residents. Efficacy of an Internet-Based Learning Module and Small-Group Debriefing on Trainees’ Attitudes.pdf
In the mid to late 1980s, the cocaine epidemic flooded the hospital maternity service with moms delivering cocaine exposed infants. At one point 22% of babies born in Philadelphia were exposed in utero (data from the Philadelphia Perinatal Society). The C-L service was inundated with requests to evaluate and refer the moms. Despite the women’s willingness to acknowledge their crack cocaine use and request help for their cocaine addiction, there was a paucity of gender specific treatment options available. I was fortunate enough to have colleagues in OB-Gyn and Pediatrics who collaborated with me to collect the needed data and develop a plan for an addiction treatment program for women. We received our first SAMHSA grant in 1990 after several applications to NIDA and the Caring Together Program, now almost 36 years old, was born. We imagined an integrated multi- disciplinary clinic that would provide addiction, psychiatric, pediatric and women’s health treatment in one location for the women and their children in our program, several decades before integrated care was popular. Funding that fully integrated care in the 1990s was financially challenging and we currently provide integrated psychiatric and addiction treatment with established referral resources for other healthcare for our 150 participants. And, we found the very high rate of co-occurring psychiatric and medical disorders in our treatment population astounding.
Medical education remains an essential part of our mission. We have PGY 2 psychiatric residents, 4th year medical students, psychiatric nurse practitioner and physician assistant students on rotation with us and both Family Medicine and Pediatric residents come as observers several times in their second year of residency. I firmly believe exposure to patients in treatment and in recovery is essential as patients are always our best teachers. I continue to badger the educational leadership in my medical school to improve our undergraduate addiction medical education.
I feel very privileged that my career has evolved along the path it has. I have had the opportunity to learn so much from my patients along the way, developing a deep understanding of their many treatment needs and how the stigma that they and I have encountered in the health care system has contributed to their many untreated health care needs. We as psychiatrists have the knowledge and tools to provide the care that our very vulnerable patients need. We need to continue to convey to both our colleagues, our trainees and especially to our patients that unlike the comments from my early residency preceptors, substance use disorders are very treatable and a career in addiction medicine can be amazing and extremely gratifying.
Efficacy of an Internet-Based Learning Module and Small-Group Debriefing on Trainees’ Attitudes and Communication Skills Toward Patients With Substance Use Disorders: Results of a Cluster Randomized Controlled Trial. Read this Research Paper