Dr. Paramjit T. Joshi, American Academy of Child and Adolescent Psychiatry
Aug 27, 2014
Dr. Paramjit T. Joshi serves as the president of the American Academy of Child and Adolescent Psychiatry and the Endowed Professor and Chair in the Division of Psychiatry and Behavioral Sciences at Children's National Health System. She is also a Professor of Psychiatry, Behavioral Sciences, and Pediatrics at George Washington University School of Medicine. Her research focuses on the psychological effects of violence and trauma in youth, and she has spent much time directing children's services in war-torn countries. We were thrilled to speak with her about her experiences as a child and adolescent psychiatrist as well as a leader in both national and international medical reform.
How did you decide on a career in medicine?
I was 16 years old at the time and it was my parents who thought this was a good profession for me. Since I trained in India, I had to make these decisions early on. I was 17 when I entered medical school. I can’t say it was my own personal decision; it was influenced by my parents.
What made you specialize in child and adolescent psychiatry?
While I was in medical school, I was very interested in pediatrics. I knew I wanted to work with children, so I became a pediatrician first. I practiced pediatrics for over 5 years in India in the late-60s/early 70s. At the time, psychiatry itself was a field that was not an option at the time. When I immigrated to the US, I knew I still wanted to work with children but there was an opportunity to expand my work with kids to treat their psychiatric and emotional needs. It made sense for me to pursue psychiatry because I wanted to work with children and child psychiatry is a unique field.
I am very interested in your role as president of the American Academy of Child & Adolescent Psychiatry. What changes do you think need to be in the field to improve the quality of patient care?
Medicine in general is changing by leaps and bounds, in the ways that we practice, train, and test in terms of core knowledge and competence. The younger generation is more akin to independent studies, so we need to focus on making our lessons more tailored for their learning style. I also think that the field needs to be more collaborative. All of the sub-specialties have been working in silos for the most part with little collaboration. For example someone takes care of the head, the heart, the lungs, etc; it has been divided and no one is taking care of the total patient. I think the time has come to do more collaborative care, which goes back to teaching and training. For example, most people that go into child psychiatry are not pediatricians. The same problem goes for pediatricians who are treating mental health issues. I think there needs to be much more cross training so that we can take care of both the somatic and emotional needs of children. Research has shown that the outcomes overall is much better. I think the time has come to be much more collaborative in our various sub-specialty fields of medicine.
I noticed that your research has focused on the psychological effects of violence and trauma in children. What do you think is the biggest challenge for physicians working with this youth population?
It depends if you’re working locally or internationally. In local terms, it comes down to coordination of care and resources. Even though it is all one country, we also need to be aware of the cultural issues that impact traumatized children. From an international standpoint, these challenges are magnified by 100 fold when there is war and trauma. Kids are really marginalized and, unfortunately, taken advantage of. They grow up to be adults who suffer enormously. For example, in the US, we have thousands of unaccompanied minors crossing the border from Mexico. What do we do for something like that? How do we apply resources? It becomes a geo-political issue which can get very complicated factors.
A lot of your work has an international component to it. For example, you have provided outreach to youth in Croatia and Bosnia Herzegovina and you have worked as a consultant for a children’s hospital in Tokyo. How have these experiences influenced your work as a physician at home?
I’m always humbled when I go overseas and see how people make do with limited resources. It is the passion that they have that drives them. When I come back home, it puts everything in perspective. I think it is very important because, otherwise, we end up having a very narrow viewpoint. There are some great programs and models of cares that are built in other countries and I can pass these experiences to my trainees and students in the US.
What advice would you give to medical students looking to pursue international medicine?
We have international electives for our fellows and I like them to work with an organized body, whether it is a medical school or another hospital. It is very difficult to go somewhere and just freelance, whereas if you go and connect with another institution, you have a better experience from a learning stand-point. You get to interact with the students and faculty. From an educational standpoint, it is a much richer experience. Before you go anywhere though, you need to be in tune with the cultural situation. You can’t go some place and have your own political views about how you view things. You have to be cognizant of what the world has to offer. Be collaborative and cooperative, be humbled, be open to ways of doing things other than what you’re used to.