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The psychiatric consultation reconsidered

Department of Child and Adolescent Psychiatry, Lanesborough Wing, St George's Hospital, Blackshaw Road, Tooting, London SW17 0RE; e-mail: dhartman{at}sghms.ac.uk

Leon Rozewicz, Consultant Psychiatrist

Park Royal Centre for Mental Health, Central Middlesex Hospital, Acton Lane, London NW10 7NS

^* Correspondence

We have subjected the current structure of the psychiatric consultation to critical examination, and we propose that the concepts of ‘history’, ‘mental state’ and ‘formulation’ should be abandoned. In their place we propose the more carefully defined concepts of ‘narrative’, ‘interaction’, ‘examination’ and ‘inferences’. The clinician should make a clear distinction between information that is reported, observed or inferred, as these sources of knowledge are qualitatively different, and subject to psychodynamic, systemic and cultural influences. We propose that this approach would facilitate a clearer and more comprehensive understanding of the patient, and lead to a more creative therapeutic relationship.