
- Vol 40, Issue 7
The Consistent Presence of the C-L Psychiatry Team
The patient’s autonomy: a guiding principle.
COMMENTARY
This article is an additional commentary on the article, "
A key function of consultation-liaison (C-L) psychiatrists is to work along with their nonpsychiatry colleagues to ethically manage patients with complex diagnoses in the hospital. As Gwendolyn Cody, MD, notes, “Mr Reese” was admitted as he was experiencing psychosis and serious illness. His refusal of treatment posed a clear risk to his survival and appeared to derive from his psychiatric illness. Although the principles of
What helped Mr Reese’s medical team cope with his rejection of treatment, and maladaptive denial of his illnesses,1 was the consistent presence of the C-L psychiatry team. The patient’s autonomy was held as a guiding principle; however, there was an empathic approach to both his medical and psychiatric needs, and the distress of his
As noted by George Henry in 1929, “On the staff of every general hospital there should be a psychiatrist who would make regular visits to the wards,…direct a psychiatric outpatient clinic,…continue the instruction and organize the psychiatric work of interns and…attend staff conferences so that there might be a mutual exchange of medical experience and a frank discussion of the more complicated cases.”2
The first formal C-L division in a general hospital was started by Edward G. Billings, MD, in Colorado in 1934. Following the principles outlined by Billings,3,4 C-L services now provide integrated care of patients with complex diagnoses in hundreds of hospitals. In the case presented here, the consideration of TOO was an option if Mr Reese could not accept necessary treatment; however, the work of the psychiatrist with the patient and the medical team allowed him to permit treatment and be safely discharged.
Dr Muskin is a professor of psychiatry and senior consultant in C-L psychiatry at Columbia University Irving Medical Center in New York, New York. He is also a member of the Psychiatric Times Editorial Board.
References
1. Strauss DH, Spitzer RL, Muskin PR.
2. Henry GW.
3. Billings EG.
4. Billings EG.
Articles in this issue
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Gender Differences in ADHD and Their Clinical Implicationsabout 2 years ago
Postpartum Psychosis: Improving the Likelihood of Early Interventionabout 2 years ago
Disparities and Opportunities in Mental Health Care for Womenabout 2 years ago
Adolescent Substance Use: Reasons for Optimism and Concernabout 2 years ago
What a Dying Woman Sawabout 2 years ago
New Research, Treatment Issues Featured at Annual Meetingabout 2 years ago
Analyzing SSRIs and Gut Microbiota in Major Depressive Disorderabout 2 years ago
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