The Organization of the Treatment Recommendation Phase in Routine Psychiatric Visits

ABSTRACT

The article examines the organization of the treatment recommendation phase in psychiatric consultations for individuals with chronic and serious psychiatric conditions. Recommending treatment in chronic psychiatric care is a complex course of action that involves building a case for a treatment recommendation, eliciting an acceptance of the proposal, checking medical records, and detailing an implementation plan. This organization allows the participants to manage the complexities of making and implementing treatment decisions in this setting, such as anticipated resistance to treatment proposals, problems with adherence to a medication regimen, and the intricacy of dealing with multiple related medications whose dosages and effects need to be carefully balanced and monitored. We show that the psychiatrist orients to getting clients’ full, informed consent to the proposed medication regimen rather than a simple acquiescence and, in doing so, balances the institutional authority to prescribe, monitor, and enforce psychotropic medications with an orientation to client involvement. The data are in American English.

Notes

¹ In the UK, this approach is commonly known as assertive outreach.

² In this article, we do not consider discussions of side-effect medications and other medications aimed to manage physical issues, such as blood pressure, diabetes, etc.

³ Unfortunately, without a video record, we cannot say if the client is nodding, for example.

⁴ In fact, we have a case (which cannot be included due to space limits) in which the client’s “too early” acceptance is dismissed as a joke.

⁵ It is possible, as one reviewer of this article suggested, that recommendations for medication switches could be quite different from dosage adjustments, given the client’s relative unfamiliarity with a new medication. We have not observed this in our data set (we only have two instances of such recommendations), but this is a fruitful direction for further investigation.