Thats what a Neurologist said.....

[Manochikitsak]

I am doing my Neurology rotations and we were considering Psychiatry consult for a patient. Our attending these days is a distinguished MD PhD Neurologist. This is what he had to say:

We should probably wait and have the pt f/u as outpatient with a Psychiatrist. I have seen that the Psychiatry service at our hospital prefers doing a "biological" work up with the patients instead of having the time to talk to them.

Any perspectives, insights or comments from my learned fellows are welcome?

P.S.- Pt came in with a Headache associated with an emotional lability and everything "neurologic" was ruled out.

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[Anasazi23]

Better to do it that way (rule-out the biologic first from a psychiatry or neurology perspective) than the other way around. The first time you get burned on that mistake, you do a lot of harm and really embarras yourself and your department.

 

[Poety]

I personally find it amusing when psych diagnoses a biological process when they're consulted for factitious d/o

 

[Miklos]

Best ones I've seen:

Inpatient on neuro ward, consulted to psych to assess for affective disorder. On admission to psych ward, received a head CT, then transferred back to neuro with a diagnosis of MS.

Other one was a consult from medicine to psych for lithium toxicity (slightly elevated level). Psych resident ordered a couple routine blood tests, including serum calcium and PTH. Voila -- hyperparathyroidism.

We all make mistakes and overlook possible diagnoses. Not only does it cause a fair bit of embarrassment, think of the possible harm to the patient.

IMO, that's why it is always best to rule out medical causes before we go digging for psych issues even if the consult comes from neuro or medicine.

 

[Anasazi23]

Last week: 80 year old woman admitted for "depression, manifested by poor PO intake. Recently released from medical floor." Patient seen crying at times for no apparent reason.

I do an abdominal exam. Stool GUAIAC (+). I transfer her to the medical floor.
Dx: Lower GI bleed.

 

[Manochikitsak]

I don't think anyone got the underlying theme of my post.

I was looking for ur comments on the perception of Psychiatry as just "talk therapy" by many non-psychiatry physicians. The point is that neurologist in question here doesn't really expect the Psychiatrists to do anything biological.

Thanks, though, for the emphasis on including medical exam and work up on Psych patients.

 

[Anasazi23]

I was looking for ur comments on the perception of Psychiatry as just "talk therapy" by many non-psychiatry physicians. The point is that neurologist in question here doesn't really expect the Psychiatrists to do anything biological.

That's just idiotic.
Just like the false accusation that neurologists can't treat anything. Point: a ridiculous false perception steeped in ignorance.

My pager isn't going off every 5 minutes to administer 'talk therapy'.

 

[watto]

That's just idiotic.
Just like the false accusation that neurologists can't treat anything. Point: a ridiculous false perception steeped in ignorance.

My pager isn't going off every 5 minutes to administer 'talk therapy'.

Ha, I'm reading a paperback written in 1972 by a psychiatrist going through residency and he is constantly lamenting how his colleagues on the surgical and medicine service thinks all he does is talk to patients...will things ever change?

 

[Manochikitsak]

That's just idiotic.
Just like the false accusation that neurologists can't treat anything. Point: a ridiculous false perception steeped in ignorance.

My pager isn't going off every 5 minutes to administer 'talk therapy'.

Wow! Thats more like a "Psychiatrist scorned." Thanks....!!!

 

[PsychEval]

OR maybe it is that the neurologist VALUES psychiatrists who have the time and training to do psychotherapy, as opposed to those who think every condition of living is a chemical imbalance in need of a million dollar work up.

 

[Manochikitsak]

Ha, I'm reading a paperback written in 1972 by a psychiatrist going through residency and he is constantly lamenting how his colleagues on the surgical and medicine service thinks all he does is talk to patients...will things ever change?

Well, thats exactly what I was trying to say. Thanks watto...!!!

And I thought, they had already changed or were in the final process of change, at least in the minds of fellow health professionals.

Not to sound too pessimistic, I have come across many physicians in the medicine and neuro rotations who seem to have a better perception of this issue.

 

[OldPsychDoc]

OR maybe it is that the neurologist VALUES psychiatrists who have the time and training to do psychotherapy, as opposed to those who think every condition of living is a chemical imbalance in need of a million dollar work up.

I think it reflects the difference between asking for an inpatient psychiatric consultation (which should really include a full biological work up as part of the diagnostic evaluation, especially if mental status changes are involved*) vs. referring for longer-term outpatient psychiatric follow-up, which can address psychotherapeutic issues more effectively.

If the neurologist was expecting a psych consult to involve in-depth psychotherapy of his inpatient, his expectations were rather far off.

*Can't believe how many times we've had to advise neurology services on appropriate workup for reversible causes of dementia on these patients!

[with respect to original post--the neurologist in question probably did both the pt and the psych consult team a service here, as the psych c/s is most likely going to be in the position of having nothing more to say than, "Yep--stress related headache, refer for outpatient management"]

 

[Manochikitsak]

[with respect to original post--the neurologist in question probably did both the pt and the psych consult team a service here, as the psych c/s is most likely going to be in the position of having nothing more to say than, "Yep--stress related headache, refer for outpatient management"]

Right on... I was going to put this in my post but decided to wait for the responses to come in and wait for someone to point it out.