Avast, thar, ’tis International Speak Like a Scurvy Pirate Day, even fer consultin’ psychiatrists! No kidding, September 19, is the official day for talking like a pirate. In honor of it, I’m going to talk like a pirate, although a little of that goes a long way so I’ll try to tone it down some.
The topic is about how to write a decent question of a psychiatric consultant. This seems to be one of the more difficult skills to master, apparently. I’ve posted about this before.
My references for this were from a former trainee, Dr. Jeanne Lackamp, MD, who is clearly an authority and has written both a practical book chapter about the psychiatric consultation process and a tongue-in-cheek perspective piece which, in part, refers to the experience of the psychiatric resident with this persistent, mysterious issue of the consultation question [1,2]. Dr. Lackamp’s main point comes in the introduction of her chapter, translated to piratical form: Communication be th’ most crucial element ‘o th’ consultation process.
Dr. Lackamp points out that consult questions are often vague, and it’s not unusual to see a one word “question” like “capacity.” Because I’ve been in the business for a while, I can decipher this as a request for assistance in decisional capacity assessment (DCA). But it’s usually task specific and times sensitive and the requests leave out a lot of useful information. The backbone of the DCA is the 4 Abilities Model:
- The ability to understand information about one’s condition generally.
- The ability to appreciate how that information applies to one’s own situation specifically.
- The ability to reason with that information, weighing the benefits and burdens of treatment options in order to make a choice.
- The ability to express that choice clearly and consistently once made.
Mr. Psychiatric Consultant, ye barnacle-covered scurvy dog! Does this 97 year old patient with multiple medical problems now intubated on a ventilator have th’ ability to make a decision ’bout what to have fer midday meal this day?
Arrr, now that’s a question…sort of.
Another question we often encounter is about delirium. If you already know the patient is delirious, what would you ask the psychiatric consultant to do about it? As Dr. Lackamp says in her essay, “The stages of consultation-liaison psychiatry,” the Anger stage can emerge when the “question” is “Please evaluate this 80-year old for new-onset schizophrenia; she has a urinary tract infection and malnutrition.”
Mr. Psychiatric consultant, ye land lubbin’ one-eyed jack of a freeloadin’ freebooter! Does this 100 year old nursin’ home resident wit’ visual hallucinations, disorientation, inattention, ‘n pneumonia have a new onset schizophrenia?
Avast, ye chicken gizzard eatin’ buccaneer of a Surgical Consultant! What would be th’ best way to remove th’ barnacles from this 76 year old barnacle-covered sea rover admitted from the ER last nightfall?
Belay ye, grog-sloshin’, squid fishin’ picaroon of a Psychiatric Consultant! Git yer Jolly Roger over here ‘n render us a hand with a 34 year old corsair siccin’ his mangy parrot on us.
Dr. Lackamp’s guidance seems germane: “Consult questions may be difficult to discern or they may have “hidden agendas” or “covert” motivations. The challenge is to determine what you can do to help the patient and primary team.”
Shiver me timbers…th’ Speak Like a Scurvy Pirate Day Song. Them that be harrrd ‘o hearin’ gunna be th’ lucky ones!
1.Lackamp, J. M., MD (2010). The consultation process. Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry. J. J. Amos, MD, and R. G. Robinson, MD. New York, Cambridge University Press: 1-14.
2.Lackamp, J. M. (2015). “The stages of consultation-liaison psychiatry.” Acad Psychiatry 39(2): 217-219.
Note: Pirate expression based on this handy translator.