To Thy Own Self Be True: Contributions from Consultation-Liaison Psychiatry
This chapter examines transference and countertransference experiences in various clinical scenarios involving requests for discharge against medical advice (AMA). It highlights those psychiatric disorders more highly associated with AMA discharges. Transference and countertransference toward patients, including those without psychiatric diagnoses, can impact how the primary team makes decisions regarding the patient’s request to sign out. It is always worthwhile to ask, “What about my feelings towards the patient might influence my willingness or lack of willingness to agree with the patient’s request?” Patients with psychiatric diagnoses are more likely to request discharge AMA, especially those patients with substance use disorders. Consultation-liaison psychiatrists are particularly equipped to assess patients with active psychiatric disorders who are requesting discharge AMA or patients who are requesting discharge and whose capacity to do so is unclear. They are a resource for the physician to guide the process to allow a patient to leave or to not allow a patient to leave.
KeywordsTransference Countertransference Psychiatric diagnoses Consultation-liaison psychiatry
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