A few of the posts above (especially comp1’s (no offense)) indicate why I am very skeptical of the “but patients are going to want to see a person for their psychiatric care” argument. I don’t think a lot of psychiatric providers have good insight into how they are perceived by patients. As a psychiatrist and administrator for over a decade, I have heard a good deal of patient feedback about psychiatrists and midlevels. There is this strange old school psychodynamic aspect that comes into play at times on the provider side especially around boundaries that patients do not appreciate or understand, and it’s honestly a bit silly. All doctors of all specialties obviously need to have boundaries, but we couch it in antiquated terminology and ideas.
Flightdoc, my advice is take as much time as you are able to listen to your patients and provide feedback. Politely let them know that time is limited. Let them know you’ve heard them and that you will refer them to an appropriate provider or have an ER social worker speak with them further.
There's some merit here, but you're missing a lot of the very relevant context. OP is NOT a psychiatrist, they are an ER physician. Even if they are good at providing supportive therapy, a 1-time administration of supportive therapy is almost certainly not going to resolve the reason the patient is in the ER and inappropriate or incorrect administration can actually create further harm in an individual who is likely in the highest acuity state they will be seen.
Additionally, many docs who practice in one setting, especially for an extended period of time, forget that the treatment goals of different settings are dramatically different and that the ER is a unique setting in the sense that it's more of a gateway into real, appropriate treatment than a location for (MH) treatment at all. The primary goal of ER psychiatry is to triage patients to determine what TYPE of treatment they need (psych vs medical), the level of treatment (OP vs IP vs involuntary), and what resources will be necessary if they can be provided there. It is NOT to administer acute treatment unless it is to maintain patient and staff safety. To the point in the previous paragraph, this does not mean that the patient should not be seen for therapy or a real psychiatrist, it just means that the ER is not the place where meaningful treatment or change is going to occur, it's essentially a holding area to ensure patient safety until we can get them to those places where meaningful treatment can happen.
All that said, there are certainly cases or situations where some brief supportive interventions can make a major difference, typically in acute stress/adjustment reactions. However, these people are the exception to the rule that the ER is largely a sorting center and that the goal of good supportive therapy is to keep the transition to the next setting as smooth and comfortable as possible.
Final point to the first bolded: I think a lot of psychiatrists have very good insight into how they're perceived and understand that they are often perceived negatively or as a barrier to what the patient really wants. I would argue that the second bolded point that the patients don't understand what is happening is the far more relevant issue though. I find a lot of patient perceptions can be guided or altered by some simple, empathetic education as to why we are making the decisions we are in the ER and why we are or aren't going to agree with the patients. Some patients won't care or can't process that information, but psychoeducation and education about the process should absolutely be part of the brief supportive therapy provided in the ER or crisis settings. I've found from repeat patients or patients who I've seen on f/up in the outpatient clinic spoked much more highly of that basic education and communication than they did about any actual treatment. Imo, if we have no insight on the patient's perspective or don't at least make an effort, then we have no business being in this field in the first place.
