E10.4

Consult-Liaison Psychiatry

Bridge between psychiatric and medical care. Different setting, different team, different role.

Encounter card

Setting

Hospital consultation on medical/surgical patients with psychiatric concerns — delirium, agitation, capacity, depression, suicidality on medical units.

Opening move

Read the chart before seeing the patient. Speak with the consulting team about the actual question. See the patient. Assess. Communicate findings and recommendations to the primary team in their workflow.

Sample language

"(to consulting team) Tell me what you're seeing. What specifically do you need from psychiatry?"
"(to patient) I'm Dr. X from psychiatry. The medical team asked me to come see you because..."
"(written consult note) Recommendation: ... Specific actions: ..."

Listen for

What the consulting team actually wants (often different from the written reason). Medical context. Capacity questions. Risk dynamics.

Common pitfalls

Doing the consult without speaking to the consulting team. Recommendations that don't fit the medical workflow. Treating the patient as your primary patient. Failing to communicate clearly.

Red flags / escalate: Acute suicidality on medical unit (needs psychiatric sitter, possibly transfer post-stabilization). Capacity questions that are urgent.

Documentation

Structured consult note. Specific recommendations. Plan for follow-up consult if needed.

Real-world reality: C-L psychiatry is consultative billing — the work isn't paid like primary clinical care. The educational value (training medical teams about psychiatric care) often exceeds the billing value.

C-L psychiatry is collaborative consultation. You're not the primary clinician — you advise.

Warm grey-tinted clinical notebook page, pale denim accent. C-L workflow — chart first, team conversation, then patient. Margin clusters on the sequence.

Consultation-liaison psychiatry is the bridge between psychiatric and medical care. The C-L psychiatrist works with medical and surgical teams in hospitals to address psychiatric concerns in medically ill patients. The role is consultation, not primary care — you advise the medical team, you don't become the patient's primary clinician.

Read the chart before seeing the patient. Background. Medical course. Current medications. Vital signs. Recent events. Why was psychiatry called? The C-L psychiatrist who walks into the patient encounter without chart review wastes the patient's time and produces lower-quality assessment.

Speak to the consulting team. What does the team actually want from psychiatry? The written reason ("anxiety") often differs from the actual question ("the family is upset about how the patient is responding to bad news and wants psychiatric input"). The team conversation clarifies the consult question and reveals context the chart doesn't capture.

See the patient. Bring the chart-and-team-conversation context, do focused assessment for the consult question, integrate with broader clinical picture. The medical patient with new "depression" may actually have delirium; the patient with "anxiety" may have hypoxia; the patient with "psychosis" may be in alcohol withdrawal. Don't accept the consulting team's framing; assess fresh.

Communicate recommendations back in a format the team can use. Specific. Actionable. Considerate of the medical context (don't recommend medications the patient can't tolerate medically; don't recommend interventions that don't fit the medical workflow). Brief consult notes. Follow-up consult if requested.

Common C-L scenarios: Delirium (often labeled depression, anxiety, or psychosis by consulting teams). Capacity questions (the patient refusing recommended treatment). Suicide risk in medically ill patients. Adjustment to new diagnosis. Medication management questions. Family or staff conflict around patient care.

You're not the primary clinician. Don't take over the patient's care. Don't override the medical team. Don't establish ongoing outpatient relationship from the consult. The C-L role is to advise and educate; the team continues care.

Education is part of the work. The C-L psychiatrist who consistently teaches medical teams about psychiatric care improves the care patients receive long after the specific consult.

What the consulting team actually wants — often different from the written reason. Sample examples. Margin notes on inquiry.

The anchor

C-L psychiatry is consultation, not primary care. Read first, speak to consulting team, assess patient, communicate specific recommendations.

Recommendations that fit the medical team's workflow — clear, actionable, considerate of context. Margin clusters on the format.

Prove it

You're consulted on a hospitalized 70-year-old man for "depression." After review, you find no mood symptoms — but the patient is delirious post-op. What's the consult question really?

This connects to

E8.8

Geriatric Delirium

A common C-L scenario.

E4.4

Capacity Assessment

Frequent C-L consult question.

Locked concepts unlock as you reach them on the path.