Home From The Editor Drawing the line at psychiatric co-management

Drawing the line at psychiatric co-management

April 2008

Published in the April 2008 issue of Today’s Hospitalist

When it comes to co-managing patients, hospitalists have always had conflicting feelings. Co-management has been good business for hospital medicine, but it has led to concerns that hospitalists are being asked to practice beyond their training, or at times to do little more than scut work.

While hospitalists debate when and how it makes sense to co-manage the patients of medical subspecialists, one co-management dilemma may be eclipsing all others.

As this month’s cover story points out, a growing number of hospitalists are finding themselves caring for psychiatric patients. These patients are in medical units not because of their medical needs, but because they have nowhere else to go. And the hospitalists treating them have no choice in the matter.

With hospitals around the country closing psychiatric units and psychiatrists abandoning inpatient practices, hospitals “and the physicians who work there “are finding that they’re increasingly the only therapeutic option available. In some cases, these physicians are being asked to treat acutely psychotic patients, something their training didn’t prepare them for.

The hospitalists we spoke to for this month’s coverage say that they are sympathetic to these patients, but they don’t always feel comfortable managing their psychiatric conditions.

Some may argue that a big key to hospitalists’ success has been their flexibility and their willingness to take whatever comes their way. That may be true, and our cover story does offer a few solutions to expand hospitalists’ comfort zone. But for a number of hospitalists, psychiatric co-management is where they’re drawing the line and looking for ways to improve their resources as the physicians of last resort.

edoyleEdward Doyle
Editor and Publisher

edoyle@todayshospitalist.com