Chapter 1 - The consultation process

Summary

Consultation psychiatrists are skilled clinicians and expert liaisons in the general hospital setting. Clear communication improves the process of the consultation as well as the result, by ensuring accurate, timely, and helpful interventions. The first steps in the consultation process include the institutional and personal organization, consulting individual, patient, consult question and acuteness of the consult. Medications can be the cause and cure formyriad psychiatric issues. Identifying unnecessary and/or psychiatrically offensive medications is a significant part of consultation psychiatry. Anticholinergic medications, benzodiazepines, and narcotics are particularly deliriogenic in the medically ill or debilitated. Interventions other than medications can be helpful as well, including reorienting and reassuring the patient as needed, providing necessary assistive devices (including hearing aids and eyeglasses), using interpretive services when needed, explaining procedures and communicating clearly with the patient, and having family meetings.