Fortunately, she says, “even though these situations can arise, they are the exception rather than the rule.”
“Communication between caregivers is really important in creating a unified treatment plan that is coherently presented to the patient in a single voice.”
—Marie Tobin, MD, associate professor of psychiatry and consult-liaison psychiatrist, University of Chicago Pritzker School of Medicine
16. Consider the possibility of a factitious disorder when there is a lack of objective evidence for pathology to explain a patient’s symptoms despite extensive evaluation.
For example, Dr. Ruhnke says, if a patient complains of hemoptysis and hematochezia with negative endoscopies, talk to the nurse about the patient’s diet, and be suspicious if it includes only red foods and liquids. The most common symptoms among patients who come to medical attention because of factitious disorders are diarrhea, fever of unknown origin, gastrointestinal bleeding, hematuria, seizures, and hypoglycemia.
17. Choose an intravenous psychiatric medication when a patient with severe and persistent mental illness should avoid oral medication for a procedure.
A patient with schizophrenia or bipolar disorder could experience a severe psychiatric episode without psychiatric medication. An appropriate alternative, perhaps administered intravenously if necessary, “can make all the difference in the world,” says Christopher Dobbelstein, MD, assistant professor of psychiatry at the University of Pittsburgh School of Medicine.
18. Listen to your instincts.
Medical teams can handle many psychiatric issues. Straightforward delirium is a good example. The bigger question, which takes experience and confidence, is to recognize when a line has been crossed. “The decision to consult psychiatry is not formulaic,” Dr. Dobbelstein says.
Sometimes a patient is acting strangely, and the team can’t explain why a psychiatrist could offer sound advice. “That’s when they should trust their instincts and consult us,” he says, “because the patient likely does have something more complex going on.”
19. Arrange for post-discharge follow-up with a primary-care physician or psychiatrist.
Sometimes psychiatric medications are started without good oversight. Suicide risk is highest during the weeks following an inpatient psychiatric admission, so a patient should see an outpatient mental health provider within seven days after hospital discharge, says NAMI’s Dr. Duckworth.
20. Extend genuine compassion to your patients.
“This is the secret to achieving a lifelong rewarding career in medicine,” Dr. Worley says, “and is the most important ingredient in positive outcomes.”
Susan Kreimer is a freelance writer in New York.
Survival Tips
Dr. Muskin
- Pull up a chair and sit down.
- Ask what name your patient likes to go by. Be respectful and use correct titles when appropriate. One size doesn’t fit all. “Mrs. X” might be a mother-in-law.
- Appreciate how terrifying it can be as a patient—ill, in pain, having no control, with a loss of privacy and at times dignity.
- Remember that any one of us in the role of a patient regresses and copes in different ways. Some become demanding and express a strong need for control, while others want and need information from their physician.
- Privacy is important. Close the door. Don’t ask sensitive questions within earshot of other patients or visitors.