THE MEDICAL PSYCHIATRIST AS PHYSICIAN FOR THE CHRONICALLY MENTALLY-ILL

A 60-year-old black-female with chronic paranoid schizophrenia was adm itted to the Medical Service for a workup because of severe iron defic iency anemia; size refused the workup. She was found to be acutely psy chotic and incapable of informed medical decision making. The manageme nt of her medical workup by her medical/C-L psychiatrist led to a diag nosis of colon cancer, and subsequent surgery. The case is discussed h ere by a consultation-liaison psychiatrist and a lawyer bioethicist. I t illustrates the role of medical/C-L psychiatrists as physicians for chronically mentally ill patients with serious medical illness in the general hospital, who guide the medical/surgical care of these patient s without powerful negative countertransference bias, thus balancing r espect for patient autonomy with advocacy for medical ''best interests .'' (C) 1998 Elsevier Science Inc.