The influence of consensus on the assessment of physical disease in chronic community psychiatric patients.

Abstract

Physical disease is a frequent concomitant of mental disease. The majority of chronic psychiatric patients have physical complaints. Screening physical disease on a regular basis in an ambulatory setting for chronic psychiatric patients is often impossible if only for lack of medical manpower and facilities. Especially for the nonmedical personnel of a community psychiatric unit (CPU) for chronic patients, approaching and handling physical complaints and diseases poses a formidable problem. This paper addresses the issue of screening physical disease from a completely different viewpoint than that of the often advocated but just as often infeasible routine physical examination and laboratory workup. It is argued that consensus (i.e., agreement and mutual understanding) between patient and therapist on the physical well-being of the patient may increase the accuracy with which a CPU therapist, irrespective of his/her discipline, assesses physical disease. This hypothesis was tested in a sample of 156 chronic ambulatory psychiatric patients. Consensus between patient and CPU therapist was measured by means of a questionnaire. The CPU therapist assessment on physical disease in both the consensus and no consensus group was compared with those of two external medical observers; the patients' general practitioner and a specialist in internal medicine, who followed a protocolized physical screening procedure. The results tend to support the proposed hypothesis. Replication of this study using a larger samples is recommended in order to confirm the value of consensus in the assessment of physical disease in at least some subgroups of chronic ambulatory psychiatric patients and for the implications that consensus could have for daily community psychiatric practice.