踪合病院 精神科諮問 經驗 — 그 實技要令과 이에 關한 是非 ᅳ

Controversies in Skills and Techniques of Psychiatric Consultation in a General Hospital

Although psychiatric consultation- liaison service in general hospitals has been active in Korea recently, only a very few attention has been paid on the field of consultative skills and techniques. Upon the basis o f 14 years of experience in consultation work, the author hereby proposes some guidelines on consultative skills after presenting various aspects of controversies in it. The guidelines are as follow s： (1) All consultation requests, made in written form as possible, are sent to a central office, where the secretary schedules definite appointment for the consultant. (2) The consultant responds to the request quickly：response in the same day is desirable. (3) T he consultant sees the patient at bedside. (4) The consultant is expected to blend in with the house staff： he wears a while coat and usually carries medical instruments. (5) The consultant meets with the consultee both before and after he has seen the patient： this promotes communication and improves rela-tioixship between the referring staffs and the consultants. (6) The consultant reviews the chart before he sees the patient： nursing records are particularly helpful. (7) The consultant usually checks with the consultee whether the patient is expecting this consultation： if not, the consultant asks the consultee to inform it before interview. (8) The consultant approaches the patient in a fashion of didactic medical psychotherapy, putting emphasis on suggestion, clarification, education and therapeutic management, rather than in a formal form of intensive individual psychotherapy. (9) Each of the components of the consultation document, including headings, openings, history, examination and form ulation, is considered in terms of it ’s effects on the liaison with the consultee and the care of the patient： the content of recommendation is scientific, reasonble and practical. For further development of consultation-liaison psychiatry in Korea, the author places emphasis on the formal establishment of consultative-liaison psychiatry as a subspecialty, provision of increased time blocks for the consultation service, setting the consultation fee at proper level, and the training o f psychiatric residents in consultative skills.