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PSYCHIATRIC DIMENSIONS OF MEDICAL PRACTICE: PREFACE AND ACKNOWLEDGMENTS
As consultation psychiatrist, I am frequently asked to evaluate patients who are delirious, demoralized, thinking of suicide, or refusing to follow medical advice. Although these patients have cognitive disturbance, emotional distress, or maladaptive behavior, the cause of the problem is often their medical illness and treatment. For that reason, many such patients can receive excellent care from their own physicians. The aim of this article is to encourage and enable that care.
I have not discussed every medical situation with psychiatric implications. In part, this is because certain problems (e.g., the treatment of alcohol abuse, the differentiation of panic disorder from myocardial infarction) are widely understood. Delirium, demoralization, suicidal thinking, and the assessment of competence to refuse medical advice are common and often vexing problems, but they remain somewhat mysterious. If I can help my colleagues in adult primary care deal with these four situations, I will be well satisfied.
I have presented several in considerable detail, not only to illustrate that multiple factors usually combine to produce the problem discussed, but also to demonstrate that the patient’s experience of illness is sometimes the most important of those factors.
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