Problem-based learning in consultation psychiatry.

Problem-based learning (PBL) is a method of instruction gaining increased attention and implementation in medical education. In PBL there is increased emphasis on the development of problem-solving skills, small group dynamics, and self-directed methods of education. A weekly PBL conference was started by a university consultation psychiatry team. One active consultation service problem was identified each week for study. Multiple computerized and library resources provided access to additional information for problem solving. After 1 year of the PBL conference, an evaluation was performed to determine the effectiveness of this approach. We reviewed the content of problems identified, and conducted a survey of conference participants. The most common types of problem categories identified for the conference were pharmacology of psychiatric and medical drugs (28%), mental status effects of medical illnesses (28%), consultation psychiatry process issues (20%), and diagnostic issues (13%). Computerized literature searches provided significant assistance for some problems and less for other problems. The PBL conference was ranked the highest of all the psychiatry resident educational formats. PBL appears to be a successful method for assisting in patient management and in resident and medical student psychiatry education.

Physician recognition of hypochondriacal patients.

To examine primary care physician recognition of hypochondriacal patients, we identified a series of such patients in a general medicine clinic using the Whiteley Index. Clinic physicians made blind global ratings of severity of physical disease and unreasonable fear of illness (hypochondriasis) and completed a checklist of somatizing characteristics. Patient records were audited for diagnoses, laboratory tests, consultations, and medications prescribed. Twenty-nine (14%) of 210 patients scored above an established cutoff on the Whiteley Index. These hypochondriacal patients were rated by clinic physicians as more hypochondriacal and were more often given psychiatric diagnoses. Also, clinic physicians identified more somatizing features among hypochondriacal patients including their own reaction to them. This recognition of hypochondriac characteristics may have contributed to better management but may need to be raised to the diagnostic level for maximum benefit.