Derivaciones Al Psiquiatra En El Hospital General: Una Visión Psicodinámica

Abstract

Introduction. It is not clear as to the process by which the psychiatrist attracts referrals and the reasons and motivations that doctors have for referring or not. This study describes the modus operandi of referrals to the psychiatrist in the context of a university general hospital. Method. A semi-structured interview was carried out on 50 doctors (35 male, 15 female) from the teaching hospital of the Universidade Estadual de Campinas, Brazil. Data was analized qualitatively, by means of content analysis, according to the psychodynamic approach. Results. Some referrals need to be worked through in order for the doctor to overcome his resistance. Others are automatic: because something moved him deeply, the doctor directs his anguish and responsability outside himself, without realizing the motives that lead him to do so. Conclusion. Referral is used in a variety of ways and different things are expected of the psychiatrist, all influenced by unconcious aspects of the patient-doctor-specialist triad.252100104Lipowski, Z.J., Consultation-liaison psychiatry: The first half century (1986) General Hospital Psychiatry, 8, pp. 305-315Botega, N.J., Consultation-liaison psychiatry in Brazil: Psychiatric residency training (1992) General Hospital Psychiatry, 14, pp. 186-191Botega, N.J., (1995) Serviços de Saúde Mental No Hospital Geral, , Papirus. CampinasAyuso-Gutiérrez, J.L., Calvé Pérez, A., (1976) La Psiquiatría en el Hospital General, , Paz Montalvo. MadridFerrari, H., Luchina, N., Luchina, I.L., (1977) La Interconsulta Médico-psicológica en el Marco Hospitalario, , Buenos Aires: Nueva VisiónPritchard, M., Who sees a psychiatrist? A study of factors related to psychiatric referral in the general hospital (1972) Postgraduate Medical Journal, 48, pp. 645-651Cummins, R.O., Jarman, B., White, P.M., Do general practitioners have different referral thesholds? (1981) British Medical Journal, 282, pp. 1037-1039Fauman, M.A., Psychiatric components of medical and surgical practice II: Referral and treatment of psychiatric disorders (1983) American Journal of Psychiatry, 140, pp. 760-763Bridges, K.W., Goldberg, D.P., Psychiatric illness in inpatients with neurological disorders: Patients' views on discussion of emotional problems with neurologists (1985) British Medical Journal, 289, pp. 656-658Mendelson, M., Meyer, E., Countertransference problems of the liaison psychiatrist (1961) Psychosomatic Medicine, 23, pp. 115-122Balint, M., (1973) The Doctor, His Patient, and the Illness, , International Universities. New YorkBourne, S., Second opinion: A study of medical referrals in a seminar for general practitioners at the Tavistock Clinic, London (1976) Journal of the Royal College of General Practitioners, 26, pp. 487-495Bardin, L., (1977) Análise de Conteúdo, , Persona. Río de JaneiroKohut, H., (1980) La Restauración del Sí-mismo, , Paidós. BarcelonaBotega, N.J., Encaminhamentos ao psiquiatra e funcionamento institucional (1991) Revista da ABP-APAL, 13, pp. 27-31Knobel, M., La relación entre el médico y el psicoterapeuta en el tratamiento de la enfermedad somática (1986) Acta Psiquiátrica y Psicológica de América Latina, 32, pp. 31-40Caplan, G., (1980) Principios de Psiquiatría Preventiva, , Zahar. Río de JaneiroSarano, J., (1978) O Relacionamento como Doente: Dificuldades e Perspectivas no Relacionamento Entre Terapeutas e Clientes, , Pedagógica Universitária. Sāo Paul