De La Genèse De La Consulation Psychiatrique à L'Hôpital Général

The authors started a new psychiatric unit in a general hospital which had not benefited from psychiatric services before their arrival. They chose as their first target the consultation service, and in working with other physicians they were surprised that, on many occasions, they were not consulted about patients who needed their services but, instead, they were asked to see patients who did not need their services to a significant degree. They began then to question the reasons for the referrals and this paper is an attempt to describe the unconscious or hidden reasons that were not explicitly expressed in the consultation, be it verbal or written, but which motivated the referring physician to ask for the help of the psychiatrist. Briefly, it was discovered that the psychiatric consultation was asked for after a crisis had developed between the referring physician and his patient, and the paper examines the dynamic origins of the crisis, its development and its resolution. The authors feel that their findings might also be applied to patients in the outpatient department and they expand upon the role of the psychiatrist in the general hospital.