Reasons against referral to the psychiatrist

Abstract

SummaryConsultants practising clinical specialties other than psychiatry in six general hospitals were asked by questionnalre about reasons which might prevent the referral of patients to a psychiatrist. The purpose of the enquiry was to find out the causes of the discrepancy between the prevalence of psychiatric disorder among medical and surgical patients and the low rate of referral.Forty-five per cent of the consultants were influenced by the patient's dislike of referral; there was also evidence of marked dissatisfaction with existing psychiatric services at certain hospitals, felt chiefly by the younger consultants. Part-time consultants gave more reasons for non-referral, but there was no significant difference between medical and surgical specialties despite reported variations in referral practice.It is concluded that general hospital psychiatric units have a role to play in improving the relationship between psychiatrists and other specialties so that referral practice can meet the needs of the patient. IntroductionSeveral surveys have shown a discrepancy between the incidence of psychiatric disorder in patients attending non-psychiatric departments of general

Psychiatric Morbidity and Referral on Two General Medical Wards

“…The house physicians had to contend with a high admission rate, a short duration of stay, and an acutely ill population. Not surprisingly they tended to concentrate exclusively on the physical wellbeing of their patients, and as in other work5 [1][2][3][4][5][6][7][8][9][10][11][12][13][14] inquired or dealt with emotinal reaCtion only when these were obviously abnormal, interfered with medical management, or had been highlighted as problems by the referring general practitioners. We believe that a few screening questions about mood and psychological response to illness could be useful, without adding appreciably to the time involved in clerking.…”

Who sees a psychiatrist? A study of factors related to psychiatric referral in the general hospital

“…An obvious interpretation is that these three variables are all measures of the degree of psychiatric orientation of the physician and/or his relationship with the Psychiatric Department. Mezey & Kellett (1971) in their study found that in two hospitals out of six, 'the relationship between the psychiatrist and the other specialties was such as to prevent referrals'. In the present study it is of interest that the two units with the highest referral rates (E and H) were the two which at that time held joint undergraduate teaching sessions with a psychiatrist.…”

“…One obvious reason for this may be the ease with which tranquillizers may be prescribed for anxiety, and indeed eighteen of the patients with anxiety state were recorded as receiving a psychotropic drug. The small proportion of alcoholics who were referred is perhaps surprising, but one possibility is that it reflects an unwillingness on the part of the alcoholic patient to accept the need for help and therefore of referral to a psychiatrist (in the study of Mezey & Kellett [1971] the commonest general reason against referral was the patient's dislike of being referred to a psychiatrist).…”

“…Are they related to the patient, to the clinician, or to both? Reasons given by non-psychiatric clinicians against referral to the psychiatrist have recently been studied by Mezey & Kellett (1971) using a questionnaire, and their findings will be discussed later. This paper considers some other factors which might be related to in-patient psychiatric referral.…”

Teaching Psychosomatic Medicine: Utilizing Concurrent Perspectives

“…These include fears that patients may get an gry if referred to a psychiatrist, the spectre of stigmatization, the issue of excessive cost, prior bad experiences and poor communica tion with psychiatrists [28]. The fears that patients will not accept psychiatric referral and view it as a punishment of stigma must be discussed.…”