Here, barriers to successful referral to a psychiatrist, principles of management of medically unexplained symptoms, and tips on when to refer a patient to a psychiatrist.
The psychiatrist consultant can help primary care physicians by making a special effort to improve communication, to clarify purpose, and to emphasize the importance of diligent follow-up. Here, a list of barriers to successful referral, principles of management of medically unexplained symptoms, and tips on when to refer a patient to a psychiatrist.
â Resistance to affect
â Differences in training
â Physician-patient relationship
â Invisible psychosocial problems
â Technological imperative
â "Holistic" sounds "fringe"
â Cartesian dualism
â Refrain from early psychological explanation
â Speak patient's "physical" language, agenda
â Perform a brief physical examination at each visit
â Curtail endless search for "organic cause"
â Limit prescriptions and referrals
â Assign (NOT prn) brief regular visits
â Maintain trusting, respectful physician-patient relationship
â Psychotic symptoms
â Diagnostic questions
â Developmental problems (children/adolescents)
â Management review
â Psychopharmacology assessment/advice
â Abnormal bereavement
â Family dysfunction
â Substance abuse/addiction
â Signs of dementia
â Sleep problems
â Sexual dysfunction
â Physician frustration/anger/impotence
For details, please see "Helping Primary Care Physicians Make Psychiatric Referrals," by Don R. Lipsitt, MD, from which this Tipsheet was adapted.