The special patient on the medical/surgical ward

The "special" or favoured patient may play a very important role in the ward milieu. Such patients are discussed in terms of their adaptive function for medical and nursing staff in dealing with feelings of pessimism, anger and guilt. The attitudes of protectiveness and infantilization and staff dissention make the task of the psychiatrist hazardous when consultation is requested. Two clinical examples are discussed: one in which the issue of "specialness" was overlooked, and one in which it was dealt with. The consulting psychiatrist's own reactions of anger and therapeutic nihilism may alert him to such a patient. Intervention must take into account the trust implied in being asked to see a "special" patient and the tremendous emotional investment on the part of the staff. The consultant should use his own reactions to the patient to help staff identify the feelings aroused in them by such patients. Meeting with the staff collectively to share concerns and resolve conflict is productive and should be encouraged.