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Uses and Abuses of Psychiatric Consultation

John J. Schwab, MD; Judith Brown, MA
JAMA. 1968;205(2):65-68. doi:10.1001/jama.1968.03140280019006.
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The psychiatric consultation is used for diagnosing and treating patients, for education, and for clarification of staff problems. The referring physician abuses the consultation when he (1) does not make explicit the reason for referral, (2) uses referral as a last-resort measure, (3) ignores the nurse's role, (4) fails to refer some dying patients, (5) is inconsistent in referring patients with personality disorders, or (6) misdiagnoses organic brain syndromes. The psychiatrist abuses the consultation by (1) delaying his response, (2) not obtaining a comprehensive view of the patient—failing to review the medical record, (3) writing a lengthy consultation note filled with jargon, (4) "taking over" the referring physician's patient, or (5) not using the consultation for teaching and learning. Correct use requires proper timing, understanding the psychosocial background, and implementing recommendations for continuing care.


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