The Role of the On-Call Psychiatric Consultant

Being an Effective Consultant

The job of being a psychiatric consultant can be exciting, intellectually challenging, and unpredictable. These evaluations involve evaluating patients with diverse conditions, including those with a long-standing psychiatric illness, a new complaint, or a sudden change in mental status. At times, such consultations will be requested not because of the patient’s distress but because of the distress the patient’s behavior has generated among the staff (e.g., experiences of projective identification with a patient who has borderline personality disorder). A wide range of questions may occur to the consultant including: Why is this patient so agitated? Why does this patient have an altered mental status? Does the patient have the capacity to consent to surgery? Is this patient safe to be discharged from the hospital?

The role of the on-call consultant has two main components including:

• The relationship with the patient:

  • Remember that in most cases the consultant provides a one-time evaluation only and that follow-up care will be provided by the regular consultation-liaison team. The relationship between the consulting physician and the patient is established with the goal of answering the consult question.

• The relationship with the primary treatment team (this includes but is not limited to):

  • Generating a differential diagnosis and recommendations that help the consultee.

  • Supporting the team in managing challenging cases (e.g., managing personality disordered patients, recommending restraints for agitated patients, deciding on the need for involuntary psychiatric treatment, and recommending guardianship for demented patients).

  • Functioning in the liaison role, which entails (1) linking medical and psychiatric knowledge and skills to enrich the diagnostic formulation of the patient and help the team to generate a comprehensive treatment plan; (2) facilitating communication between the patient and the consultee; (3) educating the consultee about psychiatric issues impacting the presentation; (4) providing information about determination of decision-making capacity and involuntary psychiatric hospitalization.

Quick suggestions in doing an on-call psychiatric consultation:

• 1.

  Clarify the consult question with the consultee

• 2.

  Preform a guided evaluation of the patient

• 3.

  Create a differential diagnoses

• 4.

  Gather pertinent collateral from the chart, outpatient psychiatrist, family, friends, coworkers, etc.

• 5.

  Communicate key findings and recommendations to the team

• 6.

  Assist the team in implementing the recommendations as necessary

• 7.

  Cogent documentation of findings and recommendations

Reasons for Consultation

The most common requests for consultation involve the following categories of psychiatric diagnoses.