Medical Assessment of the Psychiatric Patient

Abstract

In the United States, emergency physicians medically assess millions of patients annually with psychiatric complaints before they are transferred to psychiatric facilities. The goal of the medical assessment is to identify and stabilize unstable medical conditions and medical mimics of psychiatric disease. Despite adequate evidence that the vast majority of significant medical conditions can be identified during the history and physical exam alone, clinicians are routinely required to order comprehensive laboratory testing prior to transferring patients to psychiatric facilities. This chapter analyzes the history and available evidence surrounding the practice previously referred to as “medical clearance,” and it makes recommendations for the emergency physician and psychiatrist to use in their daily practice.