I’m back in the saddle again after a brief hiatus according to the terms of my phased retirement contract. During my time away, I thought about what a short introduction to Consultation-Liaison (C-L) Psychiatry might include to give medical students and other trainees a snapshot look at what CL psychiatrists encounter in their work in a busy general hospital.
As I considered what to include, it occurred to me that common consult questions typically could be classified into three basic groups:
Manage Crises: This often involves assessment of medically ill patients for whom there are concerns about suicide or violence toward others, including health care professionals.
Manage Medications: Frequently, I get questions about how to manage psychiatric medications, often in patients who are being treated with multiple medications; or need authorization for clozapine (an atypical antipsychotic which usually must be authorized initially by a psychiatrist); or need adjustment of medications in the setting of medical problems like cardiac disease or bowel resection (in which absorption might be affected).
Manage Behavior: This doesn’t always involve violent behavior but may include challenging and potentially disruptive acting out in the setting of delirium, or associated with patients who might have personality disorders or abnormal illness affirming disorders.
These broad categories make up the biggest share of the concerns my colleagues in general medicine hospitalists and surgery have about a significant proportion of patients in a large hospital.