Psychiatric Consultations in a Canadian General Hospital

Abstract

This paper reports a survey of psychiatric referral patterns on the inpatient wards of a Canadian general hospital over a 5-year period. The results demonstrate the useful contributions which psychiatric consultants can make to the care of physically ill patients. The most frequent consultation requests were for assistance with diagnostic problems and the management of depression or other psychopathology accompanying physical illness. The majority of consultation patients, 69.4%, had concurrent physical and psychiatric diagnoses and could be managed collaboratively on the services from which they were referred. Only 6.64% of the referred patients were transferred to a psychiatric ward, which reflected the philosophy of the consultation-liaison service to treat the psychiatric problems of the physically ill in the medical setting. The findings from the survey are compared with reports from general hospitals in Britain and the United States where the underutilization of psychiatric consultation services has been well demonstrated. Factors influencing the referral process, including liaison activities, are discussed and the limitations of consultation-liaison psychiatry, acknowledged. Changes in medical and nursing education are suggested to promote the wider practice of comprehensive patient care.