Alumni News
Faculty
Psychiatry
In September 2021, the University of Hawai‘i John A. Burns School of Medicine (UH-JABSOM) Department of Psychiatry, along with four other UH-JABSOM departments, joined the Queen’s University Medical Group (QUMG), whose vision “is to be the preeminent medical group of the Pacific, leading the delivery of high quality, compassionate patient care that is continually advancing through education and research.” In view of this milestone of enhanced partnership between UH-JABSOM and the Queen’s Medical Center (QMC), we wanted to present this history from the unique perspective of Jon Streltzer as a trainee and faculty member during an earlier, formative chapter in local medical history, when key commitments and relationships involving UH-JABSOM, QMC, and other local hospitals, were built.
Intern at Queen’s Hospital – 1970-71
I graduated from the University of Colorado School of Medicine in 1970. During my senior year in medical school, I took my first clinical rotation in psychiatry, and because of that good experience, I decided to choose psychiatry as my specialty. In those days, internship and residency were separate, not combined as they are today. Medical students who were graduating had to apply for residency and internship at the same time, often at different institutions. My first choice for residency was Yale, and I needed to find a medical internship. After watching the Hula Bowl on TV during a snowy Christmas Day, I decided to apply to Hawai‘i for my internship. I was accepted to the Mixed Medicine program at Queen’s Hospital in Honolulu. As I recall, that was the last year that Queen’s Hospital had its own internship and residency programs. After that year, those programs were administered by the new medical school, which began in 1965 as a two-year basic sciences-focused medical school and expanded in 1973 to a four-year degree granting program, inclusive of training in the clinical sciences.
My internship class consisted of nine medical graduates, all from accredited U.S. medical schools. At least half of the medical residents at Queen’s, who were typically in charge of the interns, were graduates of foreign medical schools, so we trained in the context of cultural diversity among our patients as well as our colleagues. It turned out that three of the nine of us were accepting psychiatry residencies, although we all had said we were interested in internal medicine on our internship applications. One of my fellow interns, Dr. Bessel van der Kolk, was accepted at Harvard for his residency, and he became a very prominent academic psychiatrist well known for his studies on trauma. We became close friends and kept in touch over the years. I attended his wedding in the Netherlands.
My internship program included rotations in pediatrics at Kauikeōlani Children's Hospital (which was located at the site of the current Rehabilitation Hospital of the Pacific and which joined forces with Kapi‘olani Maternity Hospital to form the Kapi‘olani Medical Center for Women and Children in 1978) and in emergency medicine, psychiatry, and internal medicine with different attending teams at the Queen’s Medical Center.
Private psychiatrists who would admit one of their patients to the psychiatry unit could ask a resident or intern rotating on psychiatry to assist with the patient. We quickly learned that some attendings were excellent to learn under, while there was significantly variable quality in others.
The psychiatry unit was known as Pu‘uhonua. It was located on the ground floor, where diagnostic imaging services are now. There were 24 beds, two wards of 11 each, one for men and one for women, and two single-occupancy rooms for agitated patients. The charge for a ward bed was $24 per night. There were no offices in which to see patients. There was a large banyan tree in the middle of a courtyard, and patient sessions were carried out under the banyan tree. The unit was surrounded by a wall, and occasionally a young athletic patient was able to get over the wall and escape.
Electroconvulsive therapy (ECT) was performed at the patient’s bedside with the curtains closed around the bed. The psychiatrist would do the entire procedure by himself without an anesthetist. He would inject a sedative and a paralytic agent, then breathe the patient using a mask and ambu bag, then quickly press the button on the ECT machine to administer an electric shock to the brain, then quickly breathe the patient again until the paralysis abated.
Treatment protocols varied a lot from psychiatrist to psychiatrist. I remember a woman with bipolar mania who did not respond to chlorpromazine (a widely used 1st generation antipsychotic drug). The attending psychiatrist then treated her with barbiturates, which led to intoxication but did not resolve the mania. Lithium was not yet widely used at our institution at that time. When I returned to Queen’s in 1974, after my residency training at Yale, lithium was used regularly for patients with bipolar disorder with excellent effect, quite in contrast to previously used treatments. Nearly fifty years later, even with newer approved medications, lithium remains a gold standard in the treatment of bipolar disorder.
The internship salary was $600 a month when I started. Residents organized during that year and obtained a salary increase. By the time I finished my internship, my salary had risen to $720 per month. The income was sufficient for myself and my wife as our 1-bedroom apartment near Queen’s was only $175/month.
During my psychiatry rotation, I was also assigned to the outpatient mental health clinic. The outpatient clinic was on the second floor of the Harkness building and had beautiful large offices, some of which had balconies. The outpatient clinic was an exciting, happy place. Besides psychiatric residents and an intern on rotation, there were social work students and psychology interns. The head of the clinic was a friendly psychiatrist named Dr. Harry Hinson, who had a pleasant southern accent. The chief psychologist was Dr. Renée Tillich, PhD, son of the famous theologian Paul Tillich. René was a gifted therapist and a favorite teacher. He was on the UH-JABSOM Department of Psychiatry's clinical faculty for many years. The head psychiatric social worker was Gail Kurren, MSW. She developed a terrific social work department.
The prominent author of medical thrillers, Robin Cook, was an intern at Queen’s two years before me. His first book, The Year of the Intern, was about that year. He changed people’s names, but I could recognize several of the staff. His second book, Coma, was made into a popular movie.
Psychiatrist and Faculty Member at QMC and JABSOM – 1974 to present
After internship, I did a three-year psychiatric residency at Yale. After that, having loved my year in Hawai‘i, and even though I was offered a faculty position at Yale, I applied for jobs in Hawai‘i. I applied first to the new medical school and was interviewed by the chair of psychiatry, Dr. Jack McDermott. I was also interviewed for a Queen’s position by Dr. George Bolian, a faculty member who also had an administrative position at Queen’s Hospital. The salary for an assistant professor at the medical school was $25,000 per year. The salary for a starting staff psychiatrist at Queens was $28,000 a year, so I took that position. The job duties were the same either way, involving work on the inpatient, consultation-liaison, emergency, and eventually outpatient services. I supervised residents in all settings. Within a year, my salary switched to part medical school and part Queen’s, and in less than two years, I became paid by the University of Hawaiʻi as a full-time faculty member. Jack and George had an increasingly strained relationship, and I was a great admirer of Jack.
The faculty was small, and the majority were child psychiatrists. Dr. McDermott was a very prominent child psychiatrist from the University of Michigan. Dr. Walter Char, child psychiatrist and founding chair of the UH-JABSOM Section of Psychiatry, recruited Dr. McDermott in 1969 to be the first paid faculty member and Chair of Psychiatry, which had a new status as a Department, not just a Section of the Department of Medicine. Dr. McDermott then recruited more child psychiatrists, including Dr. Bolian, who became the first director of the general psychiatry training program; Dr. William Bolman, Dr. Danilo Ponce, and Dr. Marvin Mathews. Soon, Dr. Jing Hsu and Dr. Eberhard Mann joined as other child-trained faculty. General psychiatry faculty included Dr. Wen-Shing Tseng, Dr. David Kinzie (both of whom would receive national honors for their work in cultural psychiatry), Dr. Jane Waldron D.S.W., Dr. Richard Markoff, and subsequently Dr. Brian Yano. Our department also included Dr. Thomas Maretzki, Professor of Anthropology, and Dr. Anthony Marsella, Professor of Psychology. Later we had Dr. Albert Robillard, a sociologist. Dr. McDermott and Dr. Tseng put together a cultural psychiatry fellowship in the early 1970’s. Dr. David Kinzie was the first cultural psychiatry fellow. He spent a year in Indonesia and subsequently became a faculty member, eventually the head of medical student education for the department. Dr. Tseng became general psychiatry residency training director as Dr. Bolian became more involved in administration at Queen’s Hospital.
Queen’s was expanding. Pauahi Tower had just been built. It had no open wards (that housed multiple patients) and even had private rooms on the top seventh floor. A community health center grant allowed the building of a new psychiatric unit and five stories of offices for the medical school in the new university tower. The psychiatric unit opened in 1975 and was named Kekela, in honor of Fanny Kekelaokalani Young, birth mother of Queen Emma, founder of The Queen’s Medical Center. Dr. McDermott was given the choice of which floor would be for Psychiatry. The top floor, the eighth, had the best views, but Dr. McDermott chose the bottom floor, the fourth, from where a stairwell could go directly down to the third floor, where Kekela was located. Soon, however, the doors were locked and we had to use the elevator anyway.
With Kekela’s opening, psychiatric inpatients were increasingly being taken care of by faculty and residents and less so by private psychiatrists. I was assigned two residents, each of whom carried five inpatients. At the same time, I continued to run the consultation- liaison service, and I supervised the psychiatric residents in the emergency room. From 1976 until the curriculum changed to Problem-Based Learning in the 1990s I also taught the second-year medical student lecture course on psychopathology.
An important and very much appreciated aspect of the training program was the visiting professor program. A consortium of hospitals provided funds for the training programs of residents, and the funds supported visiting professors who were invited to come for a week or sometimes two to give seminars to our trainees. Psychiatry got four visiting professors per year. This arrangement was a carryover from before the medical school existed, when hospitals had their own residents and brought in mainland professors to help educate them. We were able to get the most prominent psychiatrists since they were almost always happy to come to Hawai‘i. We had luminaries like Dr. Karl Menninger, Dr. Jerry Lewis, Dr. Irvin Yalom, Dr. Herbert Spiegel, and later his son Dr. David Spiegel, Dr. Salvador Minuchin, Dr. James Strain, Dr. Thomas Hackett, Dr. Donald Klein, Dr George Vaillant, and many others. A faculty member was assigned to host the visiting professor, and faculty and residents not only learned from their expertise, but got to know them personally and often developed relationships that increased our academic achievements. I remember that my training at Yale was excellent in general but less so in child psychiatry. Yale had a prominent Child Study Center, but the child psychiatry faculty had limited contact with general psychiatry residents. As a faculty member at UH-JABSOM, I got to spend a week with Dr. Albert Solnit, the head of the Yale Child Study Center and co-author, together with Dr. Anna Freud, of the seminal book, Beyond the Best Interests of the Child. I had never had any contact with him when I was at Yale.
St. Francis Hospital, located on Liliha Street, was very supportive of the medical school and our department in the early years. Dr. McDermott, whose brother was a Catholic Jesuit priest, had a great relationship with Sister Maureen Keleher, who was the Chief Executive Officer of St. Francis Hospital. Our department had a medical-psychiatric unit there. The attending psychiatrists were Drs. Markoff, Hsu, and. Yano. First-year psychiatry residents were assigned there. Also, in those days, Kuakini Hospital sponsored a resident, who did consultation-liaison psychiatry. I would go there once a week to supervise that resident.
St. Francis had the state’s first hemodialysis program, which opened around 1968. They also had Hawaiʻi’s first kidney transplant surgeon, Dr. Livingston Wong. I had worked with the Yale New Haven Hospital hemodialysis program for two years during my residency, so I was recruited to do liaison work with the St. Francis program, 10% time, from 1976 until 1982. St. Francis had the largest dialysis program in the country at that time, with over 300 patients from all of the Hawaiian islands, including from Kalaupapa; and from Guam and Samoa. In those years, the Department of Psychiatry had a major role in supporting dialysis and transplantation services The liaison program became quite comprehensive. In addition to providing patient care, we produced excellent research that resulted in a number of publications in good journals.. I was quite active in the early national psychonephrology conferences and received an award from the American Psychiatric Association for my work in that area.
St. Francis Hospital expanded into West O‘ahu, with the opening of St. Francis West in 1990. St. Francis Liliha and St. Francis West subsequently closed in 2011. The Transplant Center, serving Hawai‘i and the Pacific, is now located at The Queen’s Medical Center, and the former St. Francis West Hospital was acquired by The Queen’s Health System and has operated, since 2014, as Queen’s Medical Center, West O‘ahu.
From 1974 into the 1990s I directed a very active psychiatric consultation service at Queen’s. We had liaison relationships with the cancer service, the medical intensive care unit, an internal medicine hospital team, and others. I directed a chronic pain clinic within the Queen Emma Clinics from1993 to 2013 that became filled with patients caught up in the opioid overprescription crisis. I served as director of the general psychiatry residency training program from 1982 until I was replaced by Iqbal “Ike” Ahmed in 1996.
In those years, Dr. McDermott was very active as a Director of the American Board of Psychiatry and Neurology. He had a team of oral board examiners that included several of our faculty. To be certified in psychiatry, one had to complete a residency and then pass a written exam. Those who passed could then take the oral exam. The oral exam was held somewhere in the continental U.S. and involved live examinations of two psychiatry patients and one neurology patient. The anxiety when taking those boards was tremendous. I progressed from being a junior examiner to senior examiner, and then a trainer of examiners. Drs. McDermott, K. Y. Lum, and I also did a research project on the board examination process that was published in the American Journal of Psychiatry.
Dr. Lum was a UH-JABSOM clinical professor of psychiatry and a respected psychiatrist at the Queen’s Medical Center, where he also served as a trustee. In 1971, he had signed my internship completion certificate as Chief of the Medical Staff.
The faculty of the department began to make more national and international connections. I became quite active in the American Academy of Addiction Psychiatry, the Academy of Consultation Liaison Psychiatry, and the International College of Psychosomatic Medicine. I organized the 17th World Congress on Psychosomatic Medicine that took place in Waikoloa on the Big Island of Hawai‘i in 2003. The main sponsors of the Congress were the UH-JABSOM Department of Psychiatry and The Queens Medical Center. The Congress was a major success, with almost 600 attendees from over 40 countries. I became president of the organization in 2009 after having served on the executive board for several years.
In the last 25 years, as the Department expanded, I have been able to specialize in Addiction and Chronic Pain. I was board-certified in Pain Management in 2000 by the American Board of Anesthesiology when such certification first became available to psychiatrists. I was then appointed by the American Psychiatric Association to be the psychiatry representative on the board examination committee that was run by the American Academy of Anesthesiology. I served three terms. As the opioid crisis developed in the United States, I was an early voice advocating against opioid treatment of chronic pain on the grounds of lack of efficacy and safety. I am a founding Board Member of the influential Physicians for Responsible Opioid Prescribing.
After retiring from my full-time faculty position at the end of 2014, I was hired back 35% time to continue to help with the Addiction Psychiatry residency program and I continue to teach about pain management, something that many psychiatry programs do not have the resources to do.
I currently am the longest-serving faculty member at the UH-JABSOM Department of Psychiatry. I am also the only staff psychiatrist at QMC who has the experience of having worked on the Pu‘uhonua psychiatric unit. I have had the privilege of training many physicians and psychiatrists who became prominent nationally and locally, including Dr. Naleen Andrade, Emeritus Chair of the UH-JABSOM Department of Psychiatry and Executive Vice President of Native Hawaiian Health and Chief Diversity, Equity, Inclusion And Social Justice (DEIJ) Officer at The Queen’s Health System; Dr. Anthony Guerrero, current Chair of the UH-JABSOM Department of Psychiatry and Clinical Program Chief of Psychiatry at QMC; and Dr. William Haning, member of the Board of Regents of the University of Hawaiʻi and a recent President of the American Society of Addiction Medicine.
Viewing this history in perspective, it is clear that the vision of Governor John A. Burns in creating the medical school led to profound improvements in the quality of health care at Queen’s and the other community hospitals, and, indeed, for the people of Hawaiʻi. Based on my view of the past and present, I foresee a future for UH-JABSOM that will continue to involve community relationships, commitments to quality and excellence, and enthusiasm about all that Hawai‘i has to offer.