THE psychiatrist, as a consultant, is occasionally asked to see a patient suspected of or known to be inducing a medical illness by ingesting pills or injecting pathogens. Under such circumstances, he may be expected (1) to confirm the existing suspicions and/or confront the patient with the facts and (2) to treat him for the underlying psychiatric disturbance responsible for his aberrant behavior.
Those instances known to us, in which psychiatrists have attempted to perform the dual roles of adversary and therapist, have resulted in dismal failures. Such results are hardly surprising. How can a psychiatrist function first as a detective or a prosecutor and then expect to be accepted as an ally or helper?
If the psychiatrist, as a consultant, is not to be placed in an impossible position, how then might he handle the situation? One way is to meet first with the referring Physician and to
Hollender MH, Hersh SP. Impossible Consultation Made Possible. Arch Gen Psychiatry. 1970;23(4):343-345. doi:10.1001/archpsyc.1970.01750040055008