Strange psychiatric consultation questions I have known

Blog Post by James J. Amos MD, University of Iowa, USA 

In a recent blog I mentioned the “wailing wall” of strange and difficult to answer psychiatry consultation questions sometimes asked by our non-psychiatry colleagues from internal medicine and surgery (blog post Amos 10/14/2010). Questions are sometimes ambiguous and often need to be reframed so that the Psychosomatic Medicine specialist can be helpful to both customers—the patient and the consult requestor. Here are some actual quotes from consultation requests tacked to our own wailing wall:

1.  “EEG shows no brain activity”

2.  “The patient doesn’t like me”

3.  “We want to know if the patient who believes they are Sponge Bob and wants to leave the MICU to start filming a new movie—is competent.”

4.  “I’m a humanitarian but can you transfer this patient to Mexico?”

5.  “The patient looked at me funny”

6.  “We are wondering whether to discharge to their own apartment a patient who is oriented only to self, cannot perform activities of daily living, and is actively hallucinating?”

7.  “I prefer not to speak with my patients”

8.  “I prefer not to speak with families”

9.  “Patient gets irritable during “that time of the month”

10.  “We are wondering if the patient should be taken off sedation before getting a history from them?”

11.  “Patient swallowed their narcotic sobriety pin and is upset that morphine was discontinued”

12.  “The patient is eating their fingers off”

13.  “Cardiac arrest”

14.  “Consult for bilateral disorder or generalized panic disorder”

15.  “Anxiety and agitation 5 minutes before Code Blue”

16.  “Please evaluate for catatonia versus brain death on intubated patient”

17.  “Patient was fine yesterday but now unresponsive. Please rule out catatonia before we work up. If catatonia ruled out, we’ll then get a head CT and labs.”

18.  “We want the consult for our own safety”

19.  “We need psychiatry’s blessing before we can feel comfortable discharging the patient”

20.  “Patient admitted for renal failure after being gored by a bull at a rodeo, please evaluate if this was a suicide attempt” 

Some are humorous and a few are mind-boggling. What they all speak to is the omnipresent opportunity for the Psychosomatic Medicine specialist to excel as an educator. Reframing the question is a skill that requires patience, diplomacy, and credibility as an expert in one’s field. What this may also indicate is the necessity to include a bit more about psychiatry in medical school clerkship programs. And it may be an opportunity for a contest, say, the most fantastic psychiatry consultation question ever received by a Psychosomatic Medicine service.

James Amos is the editor of Psychosomatic Medicine, published by Cambridge University Press

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One Response to Strange psychiatric consultation questions I have known

  1. Pingback: Changing the Culture | The Practical Psychosomaticist: James Amos, M.D.

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