Dumb Consult

My number one pet peeve psychiatry consult is for an 85-year-old woman who has suddenly become agitated and delirious, and the primary team calls asking what's going on, and have not yet checked a urinalysis. Because 9 times out of 10, the patient in this scenario is going to have a UTI, and if you just treat it, the agitation and delirium will magically disappear.

That's a dumb consult that one sees a lot. Here's one I hadn't seen before, but that my resident called to staff with me: a 78-year-old man with history of depression, has been stable on antidepressant for years, presents to the ER with complaint of loss of appetite for one month. Denies depressed mood, poor sleep, lack of energy, suicidal thoughts, change in concentration, or loss of interest in normally pleasurable activities. In other words, he's not depressed. Has had decreased appetite, weight loss, and darker stools. Family history of cancer in two brothers. ER doctors ask the psychiatry resident to see him before discharge to see if "there's something we can give him to improve his appetite."

Again, no acute psychiatric symptoms, several acute medical symptoms and risk factors. My level of annoyance was probably 8/10 when hearing about the case, then I hung up the phone & went on my merry way. The poor resident had to take probably two hours out of his day to read the guy's chart, interview him, staff him with me, and write up a detailed note. I'm soooooooooo glad I'm not a resident anymore.