Referring a patient

I am a Consultation-Liaison psychiatrist in outpatient practice. Send me the patient whose psychiatric care cannot be separated from their medical care: the depressed transplant recipient on tacrolimus, the anxious patient with a QTc of 490, the person whose third antidepressant failed and nobody has reconstructed why, the symptoms that might be psychiatric or might be the new medication. I read the chart before the visit, and I call you after it. Open to physicians seeking expert co-management, and to psychiatrists who want a second opinion on a medically complex patient.

Refer when

• The diagnosis is uncertain, or a medical cause has not been excluded
• Psychiatric illness sits alongside significant cardiac, renal, hepatic, oncological, neurological or transplant disease
• The medication list makes every psychotropic choice a pharmacology problem
• Depression or anxiety has not responded, and the trial history needs an exacting audit

What you get back

A 120-minute initial evaluation, then a consultation letter and a personal call: formulation, what was excluded and why, the plan and its reasoning. Either a single consultation with the patient returning to your care, or ongoing co-management with you copied on significant changes. Correspondence with you is part of the work and never billed to the patient.

The practice is self-pay and out of network with all plans; fees go to the patient in writing before scheduling. Adults only; no emergency or crisis care; no standalone psychotherapy or supervised withdrawal.

Reach the practice

Independent expert work — record review, written opinion, testimony — is handled separately from the clinical practice. See Expert opinion and testimony.