精神科 諮問一調停 活動에 對한 他科 醫師들의 見解

NONPSYCHIATRIC PHYSIC IANS’ OPINIONS ABOUT THE PSYCHIATRIC CONSULTATION-LIAISON SERVICE

For the purpose of evaluating present psychiatric consultation-liaison service at Seoul National Univ. Hospital, this study was conducted by the author with the structured questionaire method on 35 clinical professors and 105 residents of nonpsychiatric departments except departments of radiology, clinical pathology and anesthesiology from July 21 to 23， 1977. The residents who graduated medical school in recent 5 years from 1971 to 1976 were more thoroughly educated psychiatry with a 4 week clerkship than the professors who graduated medical school from 1936 to 1968 were. The findings and results obtained from this study are summarized as follows: 1. Most residents and professors perceived a psychiatric problem in 1 一 10% of their patients. The resident group showed high frequency at 10% tail and the professor group showed high frequency at 1&#8212;2% tail in the range of 1&#8212;10%. The perceptibility of the resident group for a psychiatric problem is higher than that of the professor group. 2. The referral rates for the psychiatric consultation of patients with a psychiatric problem were under 50% in the resident group and over 50% in the professor group. Thus, the professors consulted patients in whom they perceived a psychiatric problem more frequently than the residents did. 3. Contrary to the tendency of the professor group to consult patients with a psychiatric problem, the resident group showed the tendency to deal with the patients by themselves with special considerations to the psychiatric problem. 4. In both group the reasons for requesting tae psychiatric consultation are the management problem of obvious psychiatric disorders (75%), diagnostic uncertainty(15%) and liaison service and preventive measures (5%). 5. The most frequent reason for not requesting apsychiatric consultation was the patient’s adverse reaction to a psychiatric referral in the professor group, and the physician’s disagreement and dissatisfaction with the diagnosis and recommendations by the consultant in the resident group. 6. 70% of both groups were dissatisfied with the present consultation process in which the communication chiefly depended on the written report, and they wanted to discuss patients’ psychiatric problems with the consultant verbally. 7. Nonpsychiatric physicians* evaluations on the results of the consultation. 1) The rate of agreement of the professor group on the consultant’s diagnosis was higher than that of the resident group. The difference between the rates was significant statistically ( P < 0 . 01). 2) The professor group showed the tendency that they perceived consultant’s recommendations and advices as practical and helpful, but over half of the resident group perceived those as vague and unpractical. 3) The professor group expressed more satisfaction with the present psychiatric consultation than the resident group did. The difference between the groups was significant statistically (P<0- 01). The degree of recognition of the need for the full-time psychiatric consultant in their wards was not high. 8. Most residents and professors considered psy-chiatric consultation as an effective measure to educate the importance of psychological factors inillness and psychiatric knowledges. 9. About 90% of both groups recognized the need for more psychiatric knowledges, and expressed special interests in psychosomatic disorders, diagnosis and treatment of neurosis, and emotional problems in patients of chronic illness and terminal stage. 10. Mpst nonpsychiatric physicians expressed their wish to broaden communications and discussions about patients with psychiatrists, and advised to make diagnosis and recommendations more concrete and practical, and to fill psychiatric subspecialis