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.