Psychiatric/psychological consultation is indicated whenever another doctor asks for help with a patient. Consultation requests cover a wide range of topics in a variety of settings.
Most commonly, the consultation request is initiated by a physician from a hospital setting. This routine consultation may actually have life-and-death implications for a patient because the overt cause for referral may reflect a more serious problem. For example, the patient who appears withdrawn may be suicidal; an uncooperative patient with mild agitation may be delirious. Delay in the detection and diagnosis of these disorders may have dire consequences.
Commonly, requests for psychiatric/psychological consultations fall into several general categories:
- Evaluation of a patient with suspected psychiatric disorder, a psychiatric history, or use of psychotropic medications. The evaluation aims to properly assess the underlying psychiatric syndrome and to mitigate its effect on the medical/surgical condition.
- Evaluation of a patient who is acutely agitated. The evaluation carefully reviews the medical and psychiatric reasons for agitation (e.g., psychosis, intoxication, withdrawal, dementia, delirium) and delineates possible etiologies (e.g., toxic metabolic disturbances, cardiopulmonary, endocrine, neurologic disorders).
- Evaluation of a patient who expresses suicidal or homicidal ideation. Any patient who voices such ideation is evaluated by a psychiatric/psychological consultant.
- Evaluation of a patient who wishes to die, including one who requests hastened death, physician-assisted suicide, or euthanasia. No presumption should be made that such requests are rational until a complete evaluation has been performed.
- Evaluation of a patient who is at high risk for psychiatric problems by virtue of serious medical illness. In some circumstances (e.g., organ transplantation), a medical or surgical service or protocol may require psychiatric/psychological evaluation of all patients.
- Evaluation of a patient in an emergency situation. In emergencies, a consultation may be requested by any health professional involved with the care of the patient (subject to the rules of procedure of the hospital).
- Evaluation of a patient with a medicolegal situation (e.g., where there is a question of a patients capacity to consent to or refuse medical or surgical treatment).
- Evaluation of a patient with known or suspected substance abuse.
Evaluation of the mental health of patients with serious medical illness, formulation of their problems and diagnosis, and organization and implementation of an effective treatment plan involve complex clinical skills that require specialized training. In addition to the usual psychiatric/psychological examination, specialized knowledge about diagnosis, medicolegal issues, and psychotherapeutic and psychopharmacological interventions is necessary. The Burrell consulting psychiatrist/psychologist is familiar with the routines of the medical/surgical environment and knowledgeable about medical and surgical illnesses. The psychiatric/psychological consultant is also aware of the effects that illnesses and drugs have on behavior, especially when they contribute to or confound the diagnosis or treatment. Furthermore, the Burrell psychiatric/psychological consultant is supportive of the patient and remains sensitive to the effects of the patient on the staff.
All Burrell providers of psychiatric/psychological consultation in the general medical setting are specifically trained and licensed physicians/psychologists.
For more information on consultation services, contact:
|Burrell Behavioral Health Main Center
1300 E Bradford Parkway
Springfield, Missouri 65804