Consultation-liaison (C-L) psychiatry, also called psychosomatic medicine, is a branch of psychiatry that focuses on the interface between medicine and psychiatry. C-L psychiatric nurse practitioners (NP) typically work at a general hospital and serve as expert psychiatric consultants for the medical staff. They see patients with comorbid psychiatric and medical conditions, patients whose medical condition is causing a psychiatric condition, and patients with psychiatric conditions that present with physical symptoms.
I worked on an innovative and collaborative team of C-L psychiatric providers including social workers, counselors, physician assistants, nurse practitioners, and physicians. Each day, 20 to 30 consults would come in and be divided among the team. I would arrive at 0730 hours, check my email and await the buzzing of my pager, alerting me to my first consult.
Each day was a surprise, sending me on foot across the hospital network and across medical specialties. On an average morning I would be in the ER, burn unit, ICU/PICU/NICU/SICU, labor and delivery rooms, and dialysis unit providing expert psychiatric consultation to the medical team. A day was not complete without a case of complex delirium, alcohol withdrawal, suicide attempt, and postpartum depression.
I provided recommendations based off best practices, my specialized education, and collaborative discussions with the C-L team. I usually spent 60 to 90 minutes with each patient in their hospital room, conducting a psychiatric evaluation and brief psychotherapeutic interventions. Let’s just say I got really good at motivational interviewing. After seeing the patient, I would review the case with the patient’s nurse and then dictate a 5-10 page report listing my recommendations for the medical team. More often than not, I would collaborate closely with the entire care team and review the case via telephone with the patient’s lead medical provider.
As a C-L psychiatric nurse practitioner, I understood the complex relationship between physical and emotional well-being. I made tough decisions every day including suicide risk assessments and a patient’s capacity to make medical decisions. Should this person be committed to a psychiatric hospital against his or her will? Can this person function independently after discharge? Can this patient give informed consent? May this patient decline medical treatment or leave against medical advice?
Without a doubt, I was confronted with some of the most emotionally exhausting and sometimes traumatic moments of my life. Every day I encountered either grieving, demoralized, or mentally ill patients across the lifespan and offered what biological, psychological, and social interventions that I could. One of the hardest parts was the walk from one consult to the next: preparing for what was up ahead, and leaving behind what I had just seen. This is one of those medical specialties where you bear witness to the darkest moments in people’s lives.
In the past, I had worked in a rural outpatient mental health clinic as well as an inpatient child psychiatric hospital. By far, C-L was the more thrilling and dynamic clinical position I ever held. I had the opportunity to manage conditions like conversion disorder, psychogenic amnesia, and factitious disorder! I interfaced with every type of healthcare provider across the continuum of care. I learned something every day. To me, this was the experience of a lifetime. In the future, one of my personal dreams is to develop a C-L fellowship or residency program for psychiatric nurse practitioners so that more of us will have the opportunity to learn from this invaluable experience.
For those of you interested in learning more about C-L psychiatry, check out Amos & Robinson’s text, Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry.