An analysis of physician resistance to psychiatric consultations

Although it has been estimated that between 30% and 60% of hospital patients have an emotional problem related to and sometimes affecting the course of their hospitalization, psychiatric consultations for such patients are rarely requested. We conducted chart rounds with house and nursing staffs to identify those patients with prominent psychiatric problems relating to hospitalization. It was found that physician resistance to consultation was involved in more than 50% of cases not referred, usually because the physicians believed that there was no psychiatric problem or that psychiatry could not help, and less often because the physician thought that the patient might become upset or the patient-doctor relationship would be destroyed. The basis of the physicians' resistance was found not justified in 26 of 29 patients seen, and 23 of these patients were judged to have been helped by the psychiatrist.