Management of patient-staff and intrastaff problems in psychiatric consultations.
Four possible types of management of patient-staff and/or intrastaff (PS/IS) problems in psychiatric consultations are distinguished and operationalized. The occurrence and correlates of these types of interventions were studied in a multisite investigation of 1112 consecutive consultations in five general hospitals. PS/IS problems (possibly, probably, or certainly) played a role in 28.1% of the consultations studied. The psychiatric consultants utilized a primarily patient-oriented approach in 56.7% of these 310 consultations, whereas in 42.3% they performed (covert or overt) staff-oriented case consultations. A staff-oriented approach may be contraindicated when the PS/IS problems are not very serious or too complex. In the literature staff resistance and hospital culture are frequently mentioned as obstacles to staff-oriented interventions. The present study showed, however, that it was often the consultants' own degree of security about the PS/IS problems that determined the way they handled these problems. Staff-oriented consultations took significantly more of the psychiatric consultants' time. The clinical and economic benefits of such interventions have still to be established. But the psychiatric consultant with a true biopsychosocial approach should always be cognizant of the possible occurrence of PS/IS problems and consider applying a staff-oriented intervention.
Hengeveld
M W
MW
State University of Leiden, The Netherlands.
van der Mast
R C
RC
Tuinstra
C L
CL
D006801:Humans; D007400:Interprofessional Relations; D008505:Medical Staff, Hospital / Q000523:psychology*; D001523:Mental Disorders / Q000628:therapy*; D011369:Professional-Patient Relations; D011570:Psychiatry / Q000458:organization & administration*; D012017:Referral and Consultation