Consultation and Liaison (C & L)

Today I was assigned to the Consultation and Liaison team. This is a service offered by some psychiatrists that serves the general medical and or surgical inpatient patients. For example, if a surgeon has a patient in the hospital recovering from a surgery and it is noted that the patient has been making suicidal statements or has anxiety or is overly depressed, the surgeon will request a psychiatric consultation for that patient. The C & L psychiatrist will then come and see the patient and make recommendations for that patients mental health. Sometimes the recommendation can be that the patient needs to be admitted to the psych ward and sometimes it is just a simple psychotropic medication adjustment. 

Often the C & L team is called to clear a patient psychiatrically for discharge from the hospital. I like this type of psychiatry because it is very involved  in the medical aspects as well as the psychiatric aspects. You must understand the patient's medical condition and how it applies to their psychiatric status. Today we saw lots of interesting patients. Some of the patients were quick psychiatric evaluations where we determined that the patients were fine from a psychiatric perspective. A couple of patients required an involuntary admission into the psych unit. This is required if the patient is considered dangerous to him/herself or others. 

There is actually a fellowship program following a psychiatric residency in C & L. It is a one year program where you focus on all aspects of the medical and surgical patients with regards to their mental status. However this fellowship is not a requirement to practice as a C & L psychiatrist. Any psychiatrist can offer this service but only some wish to be involved with this service. One of the things I do not like about psychiatry is that it is so focused on the mental health of the patient that the psychiatrist loses their medical knowledge to a certain degree. I really like the medical and surgical aspects of my training and I would hate to lose those skills over the upcoming years. For example, a seasoned psychiatrist often will be completely clueless on the current practice of treating pneumonia, or diabetes or even CPR.  This is also true of many of the other specialties as well, like a dermatologist will become lost when it comes to illnesses outside the scope of the skin. Many psychiatrists and other specialists are happy to unload these skills and just focus on their specialty. I guess you have to focus to some degree in order to become an expert in your given area but there are plenty of specialties that require a broader knowledge base of the entire spectrum of diseases.