정신과 자문에 대한 비 정신과 의사의 견해 및 태도조사

Nonpsychiatric Physicians，Opinions and Attitudes toward Psychiatric Consultation.

In order to evaluate nonpsychiatric physicians’ opinions and attitudes about psychiatric consultation, the author conducted a survey by questionnaire method to 76 physicians and 493 inpatients under their charge hospitalized in 2 general hospitals in Busan. The physicians were requested to fill up a predesigned form of questionnaire for each of their patients and individual patients were also requested to fill up a separately designed questionnaire. The results of the survey are summarized as follows. 1. The physicians recognized psychiatric problems in 47.596 (234) of their patients. Partial or total psychogenicity of the medical problems was recognized b y the charge doctors in 21% of their patients, management problem was confronted in 14% and need for differential diagnosis was felt in 8% of their patients. However, the Psychiatric symptoms were recognized in as many as 3896 of their patients which were seen as the results of complication or reaction to physical disorders. 2. The charge doctors felt psychiatric consultation, was necessary in 11% (54) of their patients, which was a drastically reduced percentage： compared to the rate of recognition of psychiatric problems. This number is only 2396 out of 234 patients whose psychiatric problems were recognized by the charge doctors, and the remaining 77% of the patients in whom psychiatric problems were recognized were somehow judged by the charge doctors as the patients who do not need psychiatric consultation. The necessity for psychiatric consultation was felt more frequently by the physicians of internal medicine than by the surgeons. The rate of physicians’ recongnition of psychiatric problems was higher in the patients for whom the psychiatric consultation was fe lt necessary. 3. Only 19 patients, i.e. 3.9% of the total subjects and 35.2% of those patients for whom psychiatric consultation was thought necessary were actually referred for psychiatric consultation. Almost two thirds of the patients for whom psychiatric consultation was felt necessary were not given an opportunity for psychiatric consultation. 4. The reasons for failure to do psychiatric consultation for whom consultation was thought necessary were “necessity of further observation，’,“patient resistance to psychiatric referral”, “psychiatric problems seen as negligible”, and “I can do it myself” etc., in order of frequency. 5. 87 patients, which is 1896 of the total subjects, wanted^psychiatric consultation. This outnumbers 54 (1196) for whom the charge doctors fe lt psychiatric consultation necessary. 66 out of the 87 patients (76%) who wanted psychiatric consultation were judged by the charge doctors do not need psychiatric consultation, and only 7 patients (8%) were ac tua lly referred for psychiatric consultation. Fourteen patients out of the 87(16%) were not consulted while psychiatric consultation was th oug h t necessary. As many as 80 patients (9296) of those who wanted psychiatric consultation were riot actually referred for consultation. In conclusion, nonpsychiatric physicians showed remarkably h igh rate of recognition of psychiatric problems in their patients. However their inclination toward psychiatric consultation and rate of actual consultation were drastically low, suggesting their high resistance to psychiatric consultation