The medical psychiatrist as physician for the chronically mentally ill.
A 60-year-old black female with chronic paranoid schizophrenia was admitted to the Medical Service for a workup because of severe iron deficiency anemia; she refused the workup. She was found to be acutely psychotic and incapable of informed medical decision making. The management of her medical workup by her medical/C-L psychiatrist led to a diagnosis of colon cancer, and subsequent surgery. The case is discussed here by a consultation-liaison psychiatrist and a lawyer bioethicist. It illustrates the role of medical/C-L psychiatrists as physicians for chronically mentally ill patients with serious medical illness in the general hospital, who guide the medical/surgical care of these patients without powerful negative countertransference bias, thus balancing respect for patient autonomy with advocacy for medical "best interests."
Schwartz
C E
CE
Department of Consultation/Liaison Psychiatry, North Central Bronx Hospital, New York, USA.
Steinmuller
R I
RI
Dubler
N
N
D000223:Adaptation, Psychological; D000230:Adenocarcinoma / Q000175:diagnosis / Q000523:psychology; D002908:Chronic Disease; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000523:psychology*; D004992:Ethics, Medical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence*; D007872:Legal Guardians; D016743:Mental Competency / Q000331:legislation & jurisprudence*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000523:psychology; D010348:Patient Care Team; D012563:Schizophrenia, Paranoid / Q000175:diagnosis / Q000523:psychology*; D012803:Sick Role; D016312:Treatment Refusal / Q000523:psychology