The consultation psychiatrist as effective physician

The two fundamental tasks of the consultation psychiatrist, diagnosis and treatment, can sometimes seem at odds with the consultee’s desired plan or outcome. While implicitly recognized, this fact is rarely explicitly taught to residents or addressed in the literature. The authors proffer three principles of inpatient consultation psychiatry aimed at dealing with tensions that can arise over issues of; 1) diagnosis (Principle I: Do not be afraid to refute notions of psychopathology); 2) medication (Principle II: Do not be afraid to discontinue unnecessary psychotropics); and 3) responsibility (Principle III: Do not be afraid to “sign off” when necessary). These principles emphasize the medical model, the status of the psychiatrist as a medical expert, and the importance of defining one’s professional limits.