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Liaison Psychiatry: Factors Influencing the Consultation Process

In the last two decades psychiatrists in liaison work have asked nonpsychiatrists to accept a greater role in the management of mental illness, sponsoring educational programs and offering consultative services to provide assistance in diagnosis and management of patients. The triadic doctor-doctor-patient relationship and transference-countertransference phenomena often have more influence on the consultation process and the effectiveness of didactic methods than real problems like the degree of availability of consultants. Such factors as 1) the circumstances of the choice of medicine as a profession, 2) the special meaning of the choice of specialty, and 3) personality factors have great influence upon the relationship between the consultant and the consultee, the quality of the consultation, and the effectiveness of educational methods used in liaison psychiatry. The results of an attitudinal survey of fifty physicians, conducted to explore conscious motivations for choosing the medical profession, attitudes toward consultation process, and less conscious elements such as fears of illness or death are discussed as a basis for understanding the consultation process and designing effective continuing education programs on the psychosocial aspects of medical care. An important implication of the study is the need to question the ways in which nonpsychiatrists are encouraged and expected to assume more responsibility for the care of patients with emotional problems.