Consultation Note Research Articles

Psychiatric Assessment and Consultation

Psychiatric Assessment and Consultation

Why don't they listen? Adherence to recommendations of infectious disease consultations.

The effectiveness of an infectious diseases (ID) consultation is dependent on adherence to the recommendations. To delineate the factors that affect adherence, we conducted a prospective cohort study of 465 consultations at 2 academic institutions in which we evaluated the consultation process, patient and consultant characteristics, types of recommendations, and compliance with recommendations. The overall compliance rate was 80%, with 85% adherence to crucial recommendations. Multivariate analysis revealed that adherence to ID recommendations was higher when the recommendations were therapeutic instead of diagnostic, when they related to a specific clinical question, when recommendations were deemed crucial by the ID service, if the primary service was medicine, and if the consultation note was legible and organized. Whether modification of consultant practice will lead to improved recommendation compliance and patient outcomes warrants further study.

A breach of "etiquette"?

A breach of "etiquette"?

Online Mendelian Inheritance in Man.

Online Mendelian Inheritance in Man.

Dermatologic Consultations—How Can We Know If We Are Effective?

I CAN WRITE WITH some experience about dermatologic consultations, since I requested so many while still an internist. Risking national ridicule, I will relate one of my experiences. Wondering if a patient with ''osteoarthritis'' and a scaly plaque perhaps had psoriasis and psoriatic arthritis, I began treating her with a midpotency topical corticosteroid and asked a dermatologist to see her. The consultation note, which was a treatise repeating the lengthy history that I knew, ended with ''Imp: LSC. Rec: Fluocinonide cream 0.05% bid.'' (a higher-potency topical corticosteroid). Once I had translated the abbreviation and looked up lichen simplex chronicus to learn that it is a localized plaque created by repeated scratching, I am sure that the consultants and I differed about the value of this consultation and my knowledge of simple skin diseases. True, the diagnosis had changed, the therapy had changed, and I had been wrong, but I was

Case notes and charting of bioethical case consultations.

In summary, the usual elements of a typical health care ethics consultation note might reasonably accommodate the needs and expectations of relevant parties, and would therefore include: 1. identification of the relevant ethical issues, questions, or dilemmas; 2. reference to any relevant facts--medical, nursing, social, psychological, spiritual, legal, political, etc.; 3. a prioritized list of recommendations to improve coordinated care; 4. a clear and concise articulation of relevant arguments, wtih specific reference to the list of recommendations as well as to the institution's overall ethos; 5. a contextual statement, identifying the perceived degree of consensus or support for the recommendations and conclusions, as well as any inherent agendas.

The art of the consultation note.

Inherent in the consultation process is the ability to communicate effectively, yet little emphasis is placed on written communication through consultation notes. The art of writing a consultation note is learned primarily through trial and error or by master/apprentice relationships with senior practitioners. This paper reviews the types of consultations in which advanced practitioners are involved and presents a format for preparing a comprehensive consultation note.

An Ethics Consultation Service in a Teaching Hospital

A newly established formal ethics consultation service in a university teaching hospital was prospectively evaluated. A physician-ethicist interviewed and examined patients, interviewed family and others as needed, and entered a formal consultation note in the medical record. The requesting physician and the consultant independently completed structured questionnaires. Fifty-one consultation requests were received from 45 physicians from seven departments between July 1, 1986, and June 30, 1987. Seventeen (33%) of 51 patients were in the intensive care unit, and 19 patients (37%) were fully oriented at the time of consultation. Overall, 61% of the patients survived to leave the hospital. The requesting physician sought assistance with withholding or withdrawing life-sustaining treatment in 49% of cases, with resuscitation issues in 37%, and with legal issues in 31%. Assistance with more than one issue was sought in 39 cases (76%). In 36 cases (71%), the requesting physician stated that the consultation was "very important" in patient management, in clarifying ethical issues, or in learning about medical ethics. We conclude that ethics consultation performed by physician-ethicists provides useful, clinically acceptable assistance in a teaching hospital.

Osler, "E. Y. D.," and hysteria.

IN ADDITION to his many other attributes, Sir William Osler (1849-1919) was highly regarded as a neurologist. His books, The Cerebral Palsies of Children 1 and On Chorea and Choreiform Affections , 2 elegantly attest to this. He was the author of occasional pseudonymous papers and letters under the nom de plume of Egerton Yorrick Davis, "late US Army Surgeon." 3 E. Y. Davis, often abbreviated as "E. Y. D.," was Osler's alter ego, his fanciful half that expressed the humorous, jesting side of his nature—a quirk that often got him into trouble. 4(pp239-242),5,6 No doubt "Yorrick" was borrowed from Shakespeare's Hamlet —"Alas, poor Yorick! I knew him, Horatio: a fellow of infinite jest, of most excellent fancy." Reproduced in the Figure is a mock consultation note written by Osler while professor of medicine at Johns Hopkins University and signed "E. Y. D." Although undated, the address allows us to place

Osier, 'E. Y. D.,' and Hysteria

IN ADDITION to his many other attributes, Sir William Osler (1849-1919) was highly regarded as a neurologist. His books, The Cerebral Palsies of Children 1 and On Chorea and Choreiform Affections , 2 elegantly attest to this. He was the author of occasional pseudonymous papers and letters under the nom de plume of Egerton Davis, late US Army Surgeon. 3 Y. Davis, often abbreviated as E. Y. D., was Osler's alter ego, his fanciful half that expressed the humorous, jesting side of his nature—a quirk that often got him into trouble. 4(pp239-242),5,6 No doubt Yorrick was borrowed from Shakespeare's Hamlet —Alas, poor Yorick! I knew him, Horatio: a fellow of infinite jest, of most excellent fancy. Reproduced in the Figure is a mock consultation note written by Osler while professor of medicine at Johns Hopkins University and signed E. Y. D. Although undated, the address allows us to place

Improving the effectiveness of psychiatric consultation

Drawing on their studies of consultation outcomes, the authors propose ways to improve consultees’ concordance with psychiatric consultants’ recommendations and diagnoses. Specific steps to improve outcome are presented. These include identification of cases at high risk for nonconcordance, attention to the form and substance of the consultation note, and monitoring the consultees’ responses to consultants’ recommendations.

Uses and Abuses of Psychiatric Consultation

The psychiatric consultation is used for diagnosing and treating patients, for education, and for clarification of staff problems. The referring physician abuses the consultation when he (1) does not make explicit the reason for referral, (2) uses referral as a last-resort measure, (3) ignores the nurse's role, (4) fails to refer some dying patients, (5) is inconsistent in referring patients with personality disorders, or (6) misdiagnoses organic brain syndromes. The psychiatrist abuses the consultation by (1) delaying his response, (2) not obtaining a comprehensive view of the patient—failing to review the medical record, (3) writing a lengthy consultation note filled with jargon, (4) "taking over" the referring physician's patient, or (5) not using the consultation for teaching and learning. Correct use requires proper timing, understanding the psychosocial background, and implementing recommendations for continuing care.