Thursday, April 24, 2008

Managing Psychiatric Patients in Medical Hospitals

Today's Hospitalist Magazine discusses the challenges of managing psychiatic patients in (medical) hospitals (via Dr. RW):

a young, depressed woman who presents to the ER after a suicide attempt with an overdose of benzodiazepines. The woman is often uninsured, and because there’s no bed at the county mental health facility, she is admitted to—and stays in—the medical ward.

The woman discussed in the above example may languish weeks on the medical ward waiting for a psychiatric bed (at a private psychiatric hospital or at a government psychiatric hospital) to open up- if she's lucky. If she's unlucky and committment paperwork has been filed, she may wait in jail for a psychiatric bed to open up. Assuming she's lucky and she gets to wait in a medical bed, who takes care of her? This role typically falls to the hospitalist (internist), who is often unprepared:

“some hospitalists are not comfortable prescribing the initial dose of certain psychiatric medications, like the newer antipsychotics.” While most hospitalists may be comfortable starting patients on antidepressants, “much further beyond that and their comfort level goes away.”

Of course, a psychiatrist (if available) is usually consulted, but he may only see the patient and leave a note several times a week.

Here are some possible solutions:

1. Reopen psychiatric wards in general hospitals. only 25% of general medical hospitals still have dedicated psychiatric units. Not profitable, so probably won't happen.

2. Open up Med/Psych wards in general hospitals. Not profitable, so probably won't happen. In addition, there are huge insurance issues with Med/Psych wards- mental health care is often covered by a mental health carve out, so the medical insurer and the psychiatric insurer will sometimes each try to deny responsibility for covering the hospitalization.

3. Give psychiatrists admitting/attending privileges at general hospitals and have them be the attending for the patient (after medical stablization). To get psychiatrists to do this, they will have to be subsidized by the hospital like many hospitalists are. Not profitable, so probably won't happen. In addition, there are the insurance issues discussed in #2.

4. The hospitalist groups could hire psychiatric nurse practitioners to help them manage these patients (using some of the subsidy they get from the hospital). Probably the most viable solution.

2 comments:

said...

A片,A片,成人網站,成人漫畫,色情,情色網,情色,AV,AV女優,成人影城,成人,色情A片,日本AV,免費成人影片,成人影片,SEX,免費A片,A片下載,免費A片下載,做愛,情色A片,色情影片,H漫,A漫,18成人

a片,色情影片,情色電影,a片,色情,情色網,情色,av,av女優,成人影城,成人,色情a片,日本av,免費成人影片,成人影片,情色a片,sex,免費a片,a片下載,免費a片下載

情趣用品,情趣用品,情趣,情趣,情趣用品,情趣用品,情趣,情趣,情趣用品,情趣用品,情趣,情趣

A片,A片,A片下載,做愛,成人電影,.18成人,日本A片,情色小說,情色電影,成人影城,自拍,情色論壇,成人論壇,情色貼圖,情色,免費A片,成人,成人網站,成人圖片,AV女優,成人光碟,色情,色情影片,免費A片下載,SEX,AV,色情網站,本土自拍,性愛,成人影片,情色文學,成人文章,成人圖片區,成人貼圖

情色,AV女優,UT聊天室,聊天室,A片,視訊聊天室

一夜情聊天室,一夜情,情色聊天室,情色,美女交友,交友,AIO交友愛情館,AIO,成人交友,愛情公寓,做愛影片,做愛,性愛,微風成人區,微風成人,嘟嘟成人網,成人影片,成人,成人貼圖,18成人,成人圖片區,成人圖片,成人影城,成人小說,成人文章,成人網站,成人論壇,情色貼圖,色情貼圖,色情A片,A片,色情小說,情色小說,情色文學,寄情築園小遊戲, 情色A片,色情影片,AV女優,AV,A漫,免費A片,A片下載

元美女 said...

(法新社a倫敦二B十WE四日電) 「情色二零零七」A片情趣產品大產自成人電影AV女優十三日起在倫敦的肯辛頓奧林匹亞展覽館舉行,倫敦人擺脫對性的保守態度成人網站踴躍參觀,許多成人網站穿皮衣與塑膠緊身衣的好色之徒擠進這項世界規模最大的成人生活展,估計三天展期可吸引八萬多好奇色情影片民眾參觀。
情色電影
A片下載動計畫AV負責人米里根承諾:「要搞浪漫、誘惑人、玩虐待,你渴望的我們都有情色。」

他說:「時髦的設計與華麗女裝,從吊飾到束腹到真人大小的雕塑,是我們由今年展出的數千件產品精選出的一部分,參展產品還包括時尚服飾、貼身女用內在美、鞋子、珠寶、玩具、影片、藝術、情色圖書及成人影片遊戲,更不要說性愛輔具及馬術裝備。」a片下載

參觀民眾遊覽兩百五a片十多個攤位,有性感服裝成人電影、玩具及情色食品,迎合各種品味。
av女優
大舞台上表演的是美國野蠻情色電影搖滾歌手瑪莉蓮曼森的前妻─全世界頭牌脫衣舞孃黛塔范提思,這是她今年在英國唯一色情一場表演。

以一九四零年代風格演出的黛塔范提思表演性感的天堂鳥、旋轉木馬及羽扇等舞蹈av

參展攤位有成人影片的推廣情趣用品,有色情的公開展示人a片體藝術和人體雕塑,也有情色藝術家工會成員提供建議。