1998 Volume 38 Issue 2 Pages 135-141
First of all, the significance of philosophy of psychosomatic medicine, which is the anthithesis of the fragmented medicine at this day, is stressed. The dilemma between clinical work and research, with which consultation-liaisonists are confronted, are discussed and its meanings are clarified. The purpose is to point out that this dilemma may be a matrix for integrative work in both clinical work and research.Then, the twenty-year history of clinical practices of consultation-liaison psychiatry at the Tokai University Hospital is reviewed in terms of structured activities and unstructuered activities, and the current issues for consultation-liaison psychiatry to deal with are discussed. Three issues are claified ; 1) crisis management as a major clinical task in current consultation-liaison psychiatry, 2) deleterious effects of brief hospitalization by the current economic and regulatory forces, on the certain aspect of teh therapeutic processes in inpatient setting of general hospital where the staff work together to understand psychological problems of patients and communicate information to each other, 3) increasing importance of community consltation-liaison psychiatry that is prompted by shortened hospitalization. The possible treatment approaches toward these issues are proposed ; 1) educational approach to hospital staff, emphasizing on working with patient on informed consent which should be started before hospitalization and maintained during hospitalization, and fascilitating early refferal to consultation-liaisonists, 2) consultation-liaisonists' needs to learn psychotherapeutic techniques of crisis intervention at various levels such as individual psychology, inpatient unit group dynamics and family dynamics, 3) making an integrated treatment plan during hospitalization and maintaining to implement it after discharge. The conclusion is made by laying stress on that medical staff should make a change in their professional standpoint, that is that patient is an informed consumer and an active partner with medical staff.
