SCOTT G. KIRBY, M.D.
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To the editor: It is common practice to require "medical clearance" of any patient presenting to an emergency department with delirium or acute psychosis before psychiatric evaluation. This clearance is also frequently demanded for patients in whom there is only the remotest possibility of finding a medical cause for their abnormal behavior. The future for psychiatric medicine predicted by Dr. McHugh (1) has prompted me to reconsider this practice, and I now wonder if such arbitrarily sequential evaluation is still appropriate.
I certainly recognize the practical concern of having a septic patient, who is coincidentally delirious, inadvertently admitted to a
KIRBY SG. "Medical Clearance" and the "Last Hurdle". Ann Intern Med. ;108:495. doi: 10.7326/0003-4819-108-3-495_2
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Published: Ann Intern Med. 1988;108(3):495.
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