SIMS Season — 2022

I’m privileged to serve as faculty for another season of Hazelden Betty Ford Foundation’s Summer Institute for Medical Students (SIMS). This page contains links to my teaching materials and some additional resources.


Many thanks to Kari Caldwell for involving me in SIMS and also the Professionals in Residence (PIR) program!


PowerPoints
Screening, Brief Intervention & Referral to Treatment (v. 05/11/2022)
Motivational Interviewing Skills Session

Key Readings [Kari will provide copies]
Alcohol Use Disorder (textbook chapter)
Taboo Topics in Addiction Treatment: An Empirical Review of Clinical Folklore (J Subst Abuse Treat 1993;10(3):303-16. PMID: 8315704)
The 10 Most Important Things Known About Addiction (Addiction 2010;105(1):6-13. PMID: 19712126)

Patient Assessment
The ASAM Criteria Assessment Interview Guideline (Adult)

Patient Resources
DBT Skills Training Handouts and Worksheets (see: Chain Analysis of Problem Behavior, p. 31)
Motivational Interviewing Workbook
REBT Pocket Companion for Clients
Rethinking Drinking (consumer health website)
Tips for Cutting Down on Drinking


I’ve long advised medical students and residents to acquire some psychotherapy skills, regardless of their eventual specialty. Motivational interviewing (MI) and cognitive behavioral therapy (CBT) are relatively easy to learn and have broad clinical utility.

Some MI resources include:

  • Miller WR, Rollnick S. Motivational Interviewing, 3d ed. New York: Guilford Press, 2013 [classic textbook]
  • Sim MG, Wain T, Khong E. Influencing behaviour change in general practice. Part 1—brief intervention and motivational interviewing. Aust Fam Physician 2009;38(11):885-888 (PMID: 19893835; and here)
  • Sim MG, Wain T, Khong E. Influencing behaviour change in general practice. Part 2—motivational interviewing approaches. Aust Fam Physician 2009;38(12):986-989 (PMID: 20369152; and here)
  • Hall K, Gibbie T, Lubman DI. Motivational interviewing techniques—facilitating behaviour change in the general practice setting. Aust Fam Physician 2012;41(9):660-667 (PMID: 22962639; and here)
  • Searight HR. Counseling patients in primary care: evidence-based strategies. Am Fam Physician 2018;98(12):719-728 (PMID: 30525356)

In terms of CBT, I highly recommend the professional trainings at the Albert Ellis Institute, starting with the primary certificate practicum. Some other resources include:

  • DiGiuseppe RA, Doyle KA, Dryden W, Backx W. A Practitioner’s Guide to Rational Emotive Behavior Therapy, 3d ed. Oxford: Oxford University Press, 2014 [classic textbook]
  • Harden M. Cognitive behaviour therapy—incorporating therapy into general practice. Aust Fam Physician 2012;41(9):668-671 (PMID: 22962640; and here)
  • Stuart MR, Lieberman JA. The Fifteen Minute Hour, 6th ed. Boca Raton: CRC Press, 2019 [please see, in particular, Chapter 4]
  • Frenz DA. Another Arrow for Your Quiver: REBT for SUD. Minneapolis: David A. Frenz, M.D., 2018 [PowerPoint presentation]

Vital Signs Are Truly Vital

I’m looking forward to presenting at the Minnesota Sheriffs’ Association’s Correctional Health Division Conference on October 13th. I’ll be discussing the use of clinical decision rules in assessing inmates for chest pain, head injuries and other high-risk presentations. You can find my PowerPoint here.

My title is a riff on the National Early Warning Score (NEWS), which has good negative predictive for really bad stuff like cardiac arrest, ICU admissions and death. I previously wrote about it for Today’s Hospitalist (and PDF version here).

Many thanks to Heather Qunell and the other conference organizers for inviting me to participate! ✸

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Postscript [10/18/2021]. Here’s a PDF of the final program.

Eat Move Sleep

I recently contributed a “lunch and learn” to PreferredOne’s annual health fair. We talked about some key topics related to behavioral change, including process thinking, end-gaining, means-whereby and indirect methods. Please see my PowerPoint for more.

The health dimension is a 30-day challenge based on Tom Rath’s Eat Move Sleep (book) and companion website. I encouraged the audience to make some small choices that could lead to big changes in both their quality and quantity of life.

Many thanks to Donna Larson, Shelley Markve, Susan Bernstein and PreferredOne’s Wellbeing Committee for pulling together the event and making the book available to employees. ✸

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Postscript [10/07/2021]. Nell Hurley brought my attention to James Clear’s Atomic Habits (book). Looks like fantastic read that syncs of up with Rath’s work. BTW, Nell was recently featured in a Star Tribune article on the contemporary sober movement.

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Postscript [10/10/2021]. For those intrigued by the Alexander Technique, I suggest booking a few lessons with Brian McCullough or another qualified teacher in your area.

Summer Institute for Medical Students

I’m privileged to serve as faculty for another year of Hazelden Betty Ford’s Summer Institute for Medical Students (SIMS). Here are my PowerPoints and some additional resources.

Many thanks to Kari Caldwell for involving me in SIMS and also the Professionals in Residence (PIR) program!


Postscript [07/30/2021]. I’ve long advised medical students and residents to acquire some psychotherapy skills, regardless of their eventual specialty. Motivational interviewing (MI) and cognitive behavioral therapy (CBT) are relatively easy to learn and have broad clinical utility.

Some MI resources include:

  • Miller WR, Rollnick S. Motivational Interviewing, 3d ed. New York: Guilford Press, 2013 [classic textbook]
  • Sim MG, Wain T, Khong E. Influencing behaviour change in general practice. Part 1—brief intervention and motivational interviewing. Aust Fam Physician 2009;38(11):885-888 (PMID: 19893835; and here)
  • Sim MG, Wain T, Khong E. Influencing behaviour change in general practice. Part 2—motivational interviewing approaches. Aust Fam Physician 2009;38(12):986-989 (PMID: 20369152; and here)
  • Hall K, Gibbie T, Lubman DI. Motivational interviewing techniques—facilitating behaviour change in the general practice setting. Aust Fam Physician 2012;41(9):660-667 (PMID: 22962639; and here)
  • Searight HR. Counseling patients in primary care: evidence-based strategies. Am Fam Physician 2018;98(12):719-728 (PMID: 30525356)

In terms of CBT, I highly recommend the professional trainings at the Albert Ellis Institute, starting with the primary certificate practicum. Some other resources include:

  • DiGiuseppe RA, Doyle KA, Dryden W, Backx W. A Practitioner’s Guide to Rational Emotive Behavior Therapy, 3d ed. Oxford: Oxford University Press, 2014 [classic textbook]
  • Harden M. Cognitive behaviour therapy—incorporating therapy into general practice. Aust Fam Physician 2012;41(9):668-671 (PMID: 22962640; and here)
  • Stuart MR, Lieberman JA. The Fifteen Minute Hour, 6th ed. Boca Raton: CRC Press, 2019 [please see, in particular, Chapter 4]
  • Frenz DA. Another Arrow for Your Quiver: REBT for SUD. Minneapolis: David A. Frenz, M.D., 2018 [PowerPoint presentation]

Some Thoughts About Thinking

I recently did a corporate “lunch and learn” on metacognition, which is our singular ability to think about our thoughts (as far as I can tell, my dog has no such capacity). This would appear abstract and likely impractical but it is actually the key to mental health.

I’m happy to work at the level of things and thoughts. The former generally involves practical solutions (problem solving) while the latter consists of philosophical solutions (e.g., cognitive behavioral therapy). But I’m much more interested in the thinker—that’s where the ultimate solution lies.

The “thinker” in this context is consciousness or awareness, which is always present but seldom appreciated. As Rupert Spira counsels, “Allow the experience of being aware to come into the foreground of experience, and let thoughts, images, feelings, sensations and perceptions recede into the background. Simply notice the experience of being aware. The peace and happiness for which all people long reside there.” Elsewhere, he advises, “Be knowingly the presence of awareness.”

You can find my PowerPoint here or by clicking on the image above. ✸


P.S. If this sounds like mindfulness, it might be. Mindfulness has become one of those everyday words that now lacks meaning, or at least a shared understanding. For an interesting perspective, please see Stephan Bodian’s Beyond Mindfulness:

“For all its wonderful benefits, the practice of mindfulness has another downside: it tends to maintain the subject–object split, the gap between the one who’s being mindful, the act of being mindful, and the object of mindful attention. In other words, no matter how mindful you become, there’s always a you that has to practice being mindful of an object separate from you. As a result, mindfulness perpetuates the very sense of separation it’s designed to overcome.”

Chasing Your Tail

Years ago, in one of my former lives, Scott Hinrichs, HealthEast’s vice president for mission, bioethics and spiritual care, tapped me to speak at its annual President’s Prayer Breakfast. I’m not sure that the audience walked away with much, however, the event was a tremendous gift to me. Absent the commitment, I doubt that I would have reflected on my spiritual journey.

The PowerPoint has generally aged well. I’m not sure that I would add much today—except, perhaps this Lars Kenseth cartoon, which I saw over the weekend, and some stuff from Stephan Bodian’s Beyond Mindfulness. By all means laugh, but then puzzle for a few minutes over the deeper meaning.

What’s that part of you that’s been there all along?

Lars Kenseth. Originally published in Wired on Wednesday, March 4th, 2020.


Postscript. I didn’t immediately realize that today marks the 10th anniversary of my presentation. More than coincidence? ✸

Self-Care During a Pandemic

Update [10/12/2020]: Here’s the recording of the session. Enjoy!

Remember airplanes? In the event of an emergency, flight attendants advise us to adjust our own oxygen masks before helping others. I’ve always found that an apt metaphor for anyone in the healing arts.

Delta Air Lines, Inc.

Tomorrow I’m presenting on self-care during a pandemic (but it could be any personal or shared crisis really). Not self-care for our patients and clients—but self-care for ourselves. The main message concerns the relationship that we have toward time and the present, although there will some other stuff sprinkled in as well.

Many thanks to the University of Minnesota’s Center for Practice Transformation for hosting the event. It’s not too late to sign up and the price is right (free)! ✸

Doubleheader

The Twins were eliminated by the Astros yesterday, however, it’s still baseball season! In that spirit, I’m “pitching” a split doubleheader today in two different ballparks through the wonders of Zoom.

The first presentation is for the Minnesota Sheriff’s Association at its Correction Care Division’s Annual Conference. The subject is identification and management of substance withdrawal syndromes (I’m the medical director for two county jails).

CentraCare Health; St. Cloud, Minn.

The second outing is for CentraCare Health at its Opioid and Controlled Substances Prescribing Training. I’m the middle reliever in a line-up that includes Drs. Michael Massey (pain medicine) and Lynn McFarling (medical informatics). The two-hour event is designed to fulfill Minnesota’s new(ish) legislative mandate for provider education. My contribution deals with unhealthy substance use with special attention to patients with chronic pain syndromes.

CentraCare Health; St. Cloud, Minn.

Just click on the above images or hyperlinked text to access my PowerPoints. ✸

Wild West of Waivers

Thank you for joining us for today’s legal/regulatory webinar related to the Covid-19 pandemic. This post contains links to the various resources that we discussed. Additional resources will be added after the event based on your questions

Disclosures
The webinar represents a partnership between Allina Health (David Frenz’s employer) and the Center for Practice Transformation. Please review Dr. Frenz’s disclosures, especially that bit about seeking counsel from experienced health lawyers like our panelists, Teresa Knoedler and Kit Friedemann


in partnership with

Questions to Ask Yourself

  1. Is the health care service permitted by law? (if yes, then go to #2)
  2. Is the health care service permitted by the patient’s health plan? (if yes, then go to #3)
  3. What is the claims submission process? For example, what CPT code and place of service code (Item Number 24B in the 1500 Health Insurance Claim Form) should be submitted for payment?


Introduction
High-level Explainer by Kit Friedemann, J.D.

Emergency Declarations
Federal
Minnesota
#StayHomeMN

HIPAA Enforcement
Office of Civil Rights resource page
Telehealth and Telemedicine Tool Kit

Medicare
Expansion of telehealth with 1135 waiver
CMS Interim Final Rule
MLN Booklet — Telehealth Services [requirements prior to Covid-19]
Medicare Coverage of Substance Abuse Services [prior to Covid-19]

Minnesota Department of Human Services
Waivers and modifications
MHCP Provider Manual

42 CFR Part 2
Substance Abuse and Mental Health Services Administration (SAMHSA)
Relationship to HIPAA enforcement discretion

Ryan Haight Act
Use of Telemedicine While Providing Medication Assisted Treatment (MAT)
Drug Enforcement Administration (DEA) Covid-19 Information Page

Predicting Suicide & Violence

I delivered this live webinar for the University of Minnesota’s Center for Practice Transformation way back on September 14th, 2018. I’m egregiously slow in posting, however, better late than never? ✸