The primary responsibility of the psychiatrist is to enhance the primary care provider’s understanding and use of psychoactive medication by providing consultation on medication decisions, changing medications, monitoring drug levels and managing side effects. The psychiatrist may also advise the behavioral health counselors, or in some instances the primary care provider directly, in cases involving complicated diagnosis and treatment. The psychiatrist’s level of involvement with individual clients may vary from minimal to extensive. In some instances, the psychiatrist may perform face-to-face assessments of clients in order to determine the best course of action and make treatment recommendations.
Generally, psychiatric consultation takes the form of:
- Telephone or “curbside” consultation, typically requests for specific information or advice about client treatment;
- In-person evaluation to perform diagnostic assessments and determine appropriate levels of care and treatment plan;
- Follow-up support, as needed and determined by the initial assessment;
- Conjoint visits with the primary care provider and client.
Access Community Health Centers have devised a suggested flow chart for primary care physician referrals to consulting psychiatrists.
Psychiatrists’ liability concerns about providing curbside consultation are addressed in a 2003 article entitled “Malpractice Liability for Informal Consultations” which concluded
Courts have consistently ruled that no physician-patient relationship exists between a consultant and the patient who is the focus of the informal consultation. In the absence of such a relationship, the courts have fund no grounds for a claim of malpractice. Malpractice risks associated with informal consultation appear to be minimal, regardless of the method of communication.”
Because psychiatrists are often in short supply, especially in rural areas, clinics have implemented different strategies to obtain their services, like the use of telepsychiatry or employment of “circuit riders” financed by group of clinics, consortia, county mental health departments, foundations, etc.