This article describes the experiences and diverse functions of a psychologist who acts as a front-line independent mental health consultant in a general hospital. Particular attention is paid to problems that arise when psyche and soma interface, because these problems require knowledge of'biology as well as of psychology. The appropriateness of this role for the psychologist and its acceptability to referring physicians are examined. The article also explores the particular strengths of the psychologist as a behavioral scientist and the need for continuing education in differential diagnosis when psychological and physiological factors interact. Professional boundaries and role relations between psychology and related professions are also reviewed.For the past 8 years, the first author of this article has functioned as a front-line consultant in a general hospital. She shares equally with two psychiatrists the consultations about adult patients on medical and surgical services. An exhaustive search of the literature revealed no prior references to clinical psychologists performing this role. Thus, this unique experience, combined with the pressure of our profession to achieve full citizenship as mental health professionals, makes it seem worthwhile to describe and evaluate this role and its relationship to the traditional roles of both the psychologist and the mental health consultant in the general hospital.Psychologists are accustomed to function as consultants in some settings. In mental health clinics, a psychologist often provides evaluations and diagnostic and therapeutic advice to other mental health professionals. And in schools, teachers who need help in working with disturbed or otherwise difficult children traditionally turn to psychologists (Bindman, 1969).But in the general medical hospital, where consultation-liaison psychiatry has re-
The extent of adherence to psychiatric consultants' recommendations was calculated through a review of charts. All charts of patients seen in Psychiatric consultation from May 1976 to April 1977 were reviewed and a total of 273 charts contained scoreable consultant recommendations. Recommendations were scored as either actively followed, passively followed or not followed. Results are reported for the extent of adherence 1) between different types of recommendations (medications, disposition, etc.), 2) between medical, surgical and obstetrical-gynecological services and 3) between consultants, two psychiatrists and one psychologist. The results suggest that recommendations more likely to be followed are those easily performed by a consultee and leading to direct, tangible results. Adherence to consultants' recommendations is discussed in the context of resistance to psychiatric consultation.
Past literature raises the question as to the degree of identification of psychiatric morbidity among medical inpatients. A psychosocial information scale was used to rate charts of seventeen inpatients who later received a psychiatric consultation and seventeen who did not during the index admission. More psychosocial items were generally present in the charts with those patients receiving later psychiatric consultation overall and specifically in the areas of psychiatric chief complaint, history of behavior change and past psychiatric history. It was concluded that many patients with psychiatric morbidity on medical wards were not so identified and this was a prime reason for their non-referral, although several of the sub-groups of such patients could benefit from psychiatric treatment. Non-psychiatrists were urged to adopt a more holistic approach to medicine with emphasis on continuity of care to insure comprehensive diagnosis and management.
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