Tipsheet: Psychiatric Referrals and Primary Care

The psychiatrist consultant can help primary care physicians by making a special effort to improve communication, to clarify purpose, and to emphasize the importance of diligent follow-up. Here, a list of barriers to successful referral, principles of management of medically unexplained symptoms, and tips on when to refer a patient to a psychiatrist.

TIPSHEET: PSYCHIATRIC REFERRALS AND PRIMARY CARE

BARRIERS TO SUCCESSFUL REFERRAL

■ Resistance to affect

■ Differences in training

■ Physician-patient relationship

■ Invisible psychosocial problems

■ Stigma

■ Technological imperative

■ "Holistic" sounds "fringe"

■ Cartesian dualism

■ Reimbursement

PRINCIPLES OF MANAGEMENT OF MEDICALLY UNEXPLAINED SYMPTOMS

■ Refrain from early psychological explanation

■ Speak patient's "physical" language, agenda

■ Perform a brief physical examination at each visit

■ Curtail endless search for "organic cause"

■ Limit prescriptions and referrals

■ Assign (NOT prn) brief regular visits

■ Maintain trusting, respectful physician-patient relationship

WHEN TO REFER A PATIENT TO A PSYCHIATRIST

■ Suicidality

■ Psychotic symptoms

■ Diagnostic questions

■ Developmental problems (children/adolescents)

■ Management review

■ Psychopharmacology assessment/advice

■ Abnormal bereavement

■ Family dysfunction

■ Substance abuse/addiction

■ Signs of dementia

■ Sleep problems

■ Sexual dysfunction

■ Physician frustration/anger/impotence

For details, please see "Helping Primary Care Physicians Make Psychiatric Referrals," by Don R. Lipsitt, MD, from which this Tipsheet was adapted.