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1.
This paper describes a consultation-liaison (C/L) teaching service that uses a medical team rounding model; four teams cover distinct geographic areas of the hospital, each team consisting of an attending psychiatrist, a resident, two medical students, and a psychology graduate student. Daily attending rounds on the medical/surgical wards provide prompt and direct patient care supervision for the team members, allowing for coordination of their activities and communication with the attending physician, who serves as a role model. Psychological testing can be readily integrated into the clinical setting; neurology and family practice residents can also get their psychiatric training in this setting. The medical team model of rounding is different from other models used on C/L services; its pros and cons are discussed.  相似文献   

2.
In this preliminary study, the experimental presence of a consulting psychiatrist at medical rounds was instituted in a busy city hospital emergency room. The psychiatrist was instructed only to respond to questions on psychiatric topics. Students were asked to record data from the discussions which occurred both with and without the presence of the psychiatrist. Our results suggest that the passive, supportive presence of a psychiatrist during medical rounds in the E.R. had a significant impact upon medical staff sensitivity to psychological topics as measured by the time spent discussing issues of a related nature. Since the study is limited to the time of the recording, no long-term conclusions can be drawn. Our work does raise significant questions, however, about medical staff sensitization to psychosocial issues and the facilitating effect of the psychiatrist in the E.R. setting.  相似文献   

3.
The profile of the psychiatrist is being affected by all kinds of developments that are occurring in psychiatry and in many other fields and disciplines. The latest profile depicts the psychiatrist primarily as a medical specialist. The biopsychosocial model has been discarded following a round of brief and confusing criticism and the focus is now on intentional brain functions. However, the latter is not completely in focus and the interpretation is ambiguous. On closer consideration we find it impossible to continue supporting the biopsychosocial model. Nevertheless, it can still serve us well as a broad-basedfamiliar-sounding paradigm. We describe a model that fits into this paradigm.  相似文献   

4.
Liaison psychiatry is traditionally practiced on the medical and surgical floors of the general hospital. The need for liaison psychiatry on the inpatient psychiatric unit as opposed to its usual setting was realized when the medical care requirements of hospitalized psychiatric patients was assessed. In many general hospitals this medical care is provided by a psychiatrist in consultation with medical and surgical colleagues. Over a three-year period at the Medical Center Hospital of Vermont 563 medical/surgical consultations were provided to the inpatient psychiatric unit. To utilize these consultations most effectively, the role best suited for the psychiatrist was that of liaison-consultee. Case examples are used to demonstrate the effectiveness of employing liaison skills in the treatment of somatic problems on the inpatient psychiatric unit. The educational implications of learning the liaison model in this context are discussed.  相似文献   

5.
A questionnaire consisting of ten items regarding the incidence, recognition, types, and workup of organic brain syndromes was administered to medical and surgical housestaff. The data revealed an average performance of 49% correct responses and 33% for the medical and surgical house staff, respectively (P < .001). Comparison of scores in relation to various personal and educatinal factors, except for departmental affiliation, revealed no statistically significant differences. The results suggested that the level of knowledge among house staff of organic brain syndromes is low. The implication is that this is a neglected area in medical school education and hospital training.  相似文献   

6.
Little attention has been paid in the literature to the special needs of family members in dealing with the sudden trauma of spinal cord injury and the long-term implications of rehabilitation. Families are often encouraged to participate in rehabilitation plans that do not take their own developmental needs into account. As a result, developmental stresses occur, often expressed as a medical crisis for the spinal cord injured patient. Requests for psychiatric consultation are a frequent initial response of the medical staff to such crisis. Two clinical cases are presented to illustrate this process. Emphasis is placed on family aspects of the cases. Data from family interviews and home visits are used to illustrate the central themes that emerged during consultations. In particular, the data illustrate how family efforts to cope with the needs of their spinal cord injured member have caused them to place inappropriate emphasis on short-term stability of family life, sacrificing, in the process, long-term growth.

Recommendations are made regarding the role of the consultation-liaison psychiatrist in the use of this family developmental approach.  相似文献   


7.
The author summarizes patient perspectives and government initiatives that have fostered closer medicine-psychiatry cooperation and more comprehensive treatment of patients. Despite the growing numbers of people requiring more formal mental health care, most patients are being treated by primary health care providers. This trend will continue as long as there is a decline in the number of medical students entering psychiatry. The author summarizes several general principles that psychiatry residency program directors should consider in designing primary care experiences for their residents and for medical students rotating on their services: longitudinal primary care experiences in organized medical care settings, training in basic medical principles and techniques, and instruction in the biopsychosocial model of disease. The author also recommends three specific training experiences for psychiatry residents that would enhance their ability to provide more effective mental health services to primary care physicians and their patients: consultation psychiatry, primary mental health care, and general psychiatry. The author concludes that medical students, throught their contact with primary care-oriented psuchiatry residency programs, would be more attracted to psychiatry as a specialty choice and that residents, upon completion of training, would be more inclined to practice in primary care settings.  相似文献   

8.
Psychiatrists and attorneys often find collaboration difficult, even when working toward mutually beneficial goals. In this commentary, a young psychiatrist reflects upon the mismatch between physicians and attorneys. Differences in medical and legal training, as well as different personality styles and approaches to problem solving, may contribute to conflict. However, psychiatrists can benefit and learn from the attorneys' approach and apply it to situations in which advocacy for good patient care and the fundamental values of medicine is necessary.  相似文献   

9.
10.
The authors emphasize the importance of a consultation psychiatry experience in the maturation of the young psychiatrist by examining some of the processes operational in both community and hospital consultation work, performed by the senior author during his fourth year of residency. Such experiences can provide opportunities for developing psychiatric skills not emphasized elsewhere, including the adoption of an active therapeutic stance, the application of the psychodynamic theory to the consultation system itself, and teaching without the use of jargon. In addition the experience as consultant facilitates the transition from residency to the outside world, not only through attitudinal changes achieved by exposure to less structured settings, a change in the supervisory model, and a solidification of identity as a physician and psychiatrist, but also by providing the resident the opportunity to begin de-cathecting from the training program.  相似文献   

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