I'm commenting to point out that psychiatry does not verify or refute a conversion disorder diagnosis. The internist expert wrote that a psychiatrist consult for conversion wasn't done as a mistake by the primary team.
The doctor doing the workup for a physical medical problem must consider all reasonable diagnoses on the differential, then it's reasonable to consider conversion disorder as a DIAGNOSIS OF EXCLUSION.
Psychiatry is not able to come in and say "yes it's conversion, there is not a physical cause for these symptoms". There is no magic assessment a psychiatrist can do to know it's all psychiatric and not a physical problem. The psychiatrist can only say the primary medical doc has done an extensive workup and not found an etiology. And typically if the patient has some acute stressor that correlates with onset of symptoms, conversion disorder is possible. But an acute stressor is not always present, or at least isn't always identifiable.
In this medmal case, a psychiatrist consulting when the initial team didn't get thoracic imaging wouldn't be able to rule out a physical cause for the patient's symptoms. If the psychiatrist suspects a conversion disorder, it rests on the assurance from the primary team that a thorough workup has been completed. A psychiatrist is not an expert on workup for leg weakness, so an error in workup would fall to the primary medical team medicolegally.
I'd just caution people doing the medical workup not to look to the psychiatrist in this way, as someone to confirm that no other medical cause is present and that something definitely is or is not conversion disorder. Or you could end up in a bad legal situation.
Hey MMR, I am loving your content. I applaud the PCP for recognizing the MRI results however I do think they should have sent the patient to the emergency department for immediate ortho/neurosurgery evaluation after they had heard from the surgeon that he wouldn't be able to see her for two weeks… May not have changed the outcome but it would have been the best thing to do.
An interesting part of this case is the expert witnesses and courts use of nursing documentation. I make it a practice to always read the nursing notes and address any inconsistencies in my note for example, “Patient reported several days of diarrhea to nursing, but denies any to me.”They are often quite useful and contain new information that the patient may not have reported to me (or more likely I forgot to ask about.) Additionally you will see gems like “MD *** aware” when in fact I was never made aware.
Wow. How could a doctor see that report in this set of symptoms and brush it off as normal? And how could a neurologist simply fail to follow up on the scan they recommended in such a serious presentation?
I'm commenting to point out that psychiatry does not verify or refute a conversion disorder diagnosis. The internist expert wrote that a psychiatrist consult for conversion wasn't done as a mistake by the primary team.
The doctor doing the workup for a physical medical problem must consider all reasonable diagnoses on the differential, then it's reasonable to consider conversion disorder as a DIAGNOSIS OF EXCLUSION.
Psychiatry is not able to come in and say "yes it's conversion, there is not a physical cause for these symptoms". There is no magic assessment a psychiatrist can do to know it's all psychiatric and not a physical problem. The psychiatrist can only say the primary medical doc has done an extensive workup and not found an etiology. And typically if the patient has some acute stressor that correlates with onset of symptoms, conversion disorder is possible. But an acute stressor is not always present, or at least isn't always identifiable.
In this medmal case, a psychiatrist consulting when the initial team didn't get thoracic imaging wouldn't be able to rule out a physical cause for the patient's symptoms. If the psychiatrist suspects a conversion disorder, it rests on the assurance from the primary team that a thorough workup has been completed. A psychiatrist is not an expert on workup for leg weakness, so an error in workup would fall to the primary medical team medicolegally.
I'd just caution people doing the medical workup not to look to the psychiatrist in this way, as someone to confirm that no other medical cause is present and that something definitely is or is not conversion disorder. Or you could end up in a bad legal situation.
Hey MMR, I am loving your content. I applaud the PCP for recognizing the MRI results however I do think they should have sent the patient to the emergency department for immediate ortho/neurosurgery evaluation after they had heard from the surgeon that he wouldn't be able to see her for two weeks… May not have changed the outcome but it would have been the best thing to do.
An interesting part of this case is the expert witnesses and courts use of nursing documentation. I make it a practice to always read the nursing notes and address any inconsistencies in my note for example, “Patient reported several days of diarrhea to nursing, but denies any to me.”They are often quite useful and contain new information that the patient may not have reported to me (or more likely I forgot to ask about.) Additionally you will see gems like “MD *** aware” when in fact I was never made aware.
Wow. How could a doctor see that report in this set of symptoms and brush it off as normal? And how could a neurologist simply fail to follow up on the scan they recommended in such a serious presentation?