E72: "Medical Clearance" of the Psychiatric Patient in the USA

Episode #72: Psychiatric Medical Clearance in the USA

As part of the emergency department (ED) evaluation of patients with psychiatric complaints, emergency physicians get asked to perform screening laboratory tests before admitting psychiatric patients, the value of which is questionable, and the evaluation of most patients presenting to the ED with a psychiatric chief complaint can be medically cleared for admission to a psychiatric facility by qualified physicians using an appropriate history and physical examination, including vital signs and an essential mental status examination.

We have proposed no need for routine medical screening laboratory tests based on current Evidenced Based Medicine (EBM) for years. Still, despite that, it has been ingrained in the institutional protocols that a certain amount of unnecessary testing must be done.

Despite the collegiate recommendations, still to this date, we do use an extensive battery of Laboratory testing (CBC, CMP, Pregnancy Test in all Women, UDS, UA, TSH, EtOH level, ASA/APAP Levels), driving up the cost of overall healthcare in America, without including other additional tests that might need to address their other chief complaints and the usage of ancillary Sonographic and Radiologic expensive workups (US / CTs / X-rays, etc.), some of them done due to fear for Medico-Legal liability or just due to protocols that have been implemented for decades that fall out of reasonable medical practice, and that to this day, remain to be part of the requirements for acceptance at long term psychiatric hospitals and mental healthcare-related facilities.

It remains a topic of enormous debate and an obvious source of financial waste. Yet, despite all this conflict, I do not see a deadline in which we can see ourselves caring for this vulnerable population anytime soon, at least to the remainder of my personal, professional medical career.

Take also into account that in the USA is not a rare occurrence to see the same patient in the ED several times a week, getting all these tests performed on them over and over, potentially contributing to morbidity, and why not, potential long term side effects, like the usage of ionizing radiation, like CTs, that has very well correlated with causing malignancies in human beings.

Having said all this, take a small dive into the topic, get acquainted and used to care and evaluate these patients in your medical wards and emergency departments thought your professional career. This topic was never taught to me as an FMG, and when I started my training in the USA, I didn't understand where this concept and process came to be!

Thanks for listening --- ONE MORE TIME !!!

Best to you all,

Your coach & mentor, 

Alonso Osorio, M.D.