Ownership, responsibility and hospital care: lessons for the consultation psychiatrist.
OBJECTIVE
To identify scenarios in which consultation psychiatrists encounter difficulty reconciling their clinical role with consultees' expectations and to suggest concepts that help navigate these situations.


METHODS
The authors' clinical experiences are used to generate and discuss three major categories of situations that require psychiatric consultants to thoughtfully adjust the breadth and depth of their obligation to patients and consultees.


RESULTS
"Occam's razor 'dulled," "Conflation of the psychosocial with the psychiatric" and "Disposition preoccupation" are proposed as the major categories leading to conflicting patient management views between consultant and consultee. Each has, at its core, a compromise of patient ownership that blurs the boundaries of the consulting psychiatrist's responsibility.


CONCLUSIONS
Understanding and channeling ownership back to the consultee, while appropriately gauging and embracing one's responsibility, form a two-pronged approach to clarifying one's role in consultations.
Kontos
Nicholas
N
Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA 02139, USA. nkontos@challiance.org
Freudenreich
Oliver
O
Querques
John
J
D000328:Adult; D003220:Conflict, Psychological; D003299:Cooperative Behavior; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis; D008875:Middle Aged; D010067:Ownership; D010346:Patient Care Management; D010348:Patient Care Team; D010360:Patient Transfer; D010819:Physician's Role / Q000523:psychology*; D010817:Physician-Patient Relations; D011570:Psychiatry; D012017:Referral and Consultation; D012941:Social Responsibility