Medical Clearance: Fact or Fiction in the Hospital Emergency Room MICHELLE RIBA, M.D. MAHLON HALE, M.D.
Prior ml'dical c1earallce is all importallr rariahh' ill rhe psychiarric assessmel/f of rhe cmergellcr room pariellr. All allalysis ofdocumellfarioll ofprior physical examillario/lS Oil a cOII.H'cmil'l' series of 137 pariel/fs seell ill a gelleral hospiral emergellcy room alld refl'rred j(lr psychiatric cOlI.wlfariOIl rel'ealed lI'ide rariallce ill physical examillariolls. The amhon discuss rhl' implicario/lS of illcomplere physical examillar;o/lSfill" psychiarry alld (~lJl'r proposals fill" Sfalldardi:arioll o(rhis importallr aspecr ofparimr eraluarioll.
motionally laden presentations by psychiatric patients are the rule in the emergency room. Inasmuch as these patients have a high incidence of physical illnesses. I -l their need for appropriate medical evaluation is particularly pressing. The degree to which emergency room psychiatrists can depend upon prior patient evaluations by medical colleagues is the subject of this study. The practice of a preceding medical evaluation-known as medical clearance-is a significant step that may affect later psychiatric care or. in some cases. postpone it. Discovery of minor medical abnormalities not requiring immediate medical allention may still cue psychiatrists to the presence of biological variables. More importantly. discovery of major medical abnormalities can alert psychiatrists to the possibility that complaints appearing psychiatric in origin in fact may
E
Received April 211. 19119: revised September 22. I
Prior ml'dical c1earallce is all importallr rariahh' ill rhe psychiarric assessmel/f of rhe cmergellcr room pariellr. All allalysis ofdocumellfarioll ofprior physical examillario/lS Oil a cOII.H'cmil'l' series of 137 pariel/fs seell ill a gelleral hospiral emergellcy room alld refl'rred j(lr psychiatric cOlI.wlfariOIl rel'ealed lI'ide rariallce ill physical examillariolls. The amhon discuss rhl' implicario/lS of illcomplere physical examillar;o/lSfill" psychiarry alld (~lJl'r proposals fill" Sfalldardi:arioll o(rhis importallr aspecr ofparimr eraluarioll.
motionally laden presentations by psychiatric patients are the rule in the emergency room. Inasmuch as these patients have a high incidence of physical illnesses. I -l their need for appropriate medical evaluation is particularly pressing. The degree to which emergency room psychiatrists can depend upon prior patient evaluations by medical colleagues is the subject of this study. The practice of a preceding medical evaluation-known as medical clearance-is a significant step that may affect later psychiatric care or. in some cases. postpone it. Discovery of minor medical abnormalities not requiring immediate medical allention may still cue psychiatrists to the presence of biological variables. More importantly. discovery of major medical abnormalities can alert psychiatrists to the possibility that complaints appearing psychiatric in origin in fact may
E
Received April 211. 19119: revised September 22. I
