Quoted from
http://forums.studentdoctor.net/showpost.php?p=10960263&postcount=32.
As someone who has interests in philosophy, psychology and politics this piqued my curiosity.
However, I can't imagine how such an effect can be made by a psychiatrist. Can anyone elaborate on this?
Even on a smaller scale than OPD suggested, it is common for a psychiatrist to get involved in deciding if this patient needs a payee, needs a different level of supervised living, needs a case manager, etc. Even at the Psych ER. All these things are typically beyond the "usual medical interaction" at the PCP office, and certainly beyond what most ER docs get into. It's just that so often these psycho-social issues are at the heart of why the pt is presenting today, so the need and the opportunity are right in our faces. For the ER doc, she might know that poverty and possible abuse at home may be underlying the ultimate cause for today's presentation, but it is not explicitly stated and the opportunity to change those issues is less directly accessible.
People come into the psych ER stating, "the stress and work and the stress at home go to the point that I was overwhelmed and I had a meltdown. I don't know if it was a "panic attack" or not, but I certainly lost it." At the medical ER, they present complaining of "I've had a headache for 3 days that won't stop." They might be due to the exact same underlying problems, but patients presenting to the psych ER expect the psychiatrist to think about such things, and they often present them right up front. At the medical ER, not so much.
When I hear from docs in other fields who are switching to psych, or just PCP's talking about the frustrations in their practice, it is these psycho-social issues that drive the conversation. "I know these social issues are creating the problems (or preventing their resolution) but I can't do anything about it in 7 minutes in my office."
My own PCP complains about this (using up 5 of the 7 minutes of MY appt), and when I suggest having the pt return in 2 weeks for a "follow-up" in which you expressly discuss these related issues, he says, "Yeah, I guess I
could do that." When he realizes I'm not going to tell him to refer them all to me, he tells me to get my labs done again in 3 months and "keep up the good work," and walks out.
