What Can Psychiatrists Bring to the Table?

Psychiatry really should be one of the earlier consultations that the primary care doctor brings onto the team. If everything is going well and the patient is progressing and getting more functional, that’s a keep going strategy. But if the patient doesn’t seem to be responding in a positive way like other patients with similar problems, then it’s time to start thinking “Who can help this patient do better?” Oftentimes what’s missed is something that’s in the larger purview of psychiatrists: a depression, a behavioral problem, a systems issue in their life, a stressor that they can’t cope with. That’s a time for the primary care doctor to say, “I’d like to get a more comprehensive picture of you, the patient, and this is who I’m going to bring in to do that.”

Psychiatry has a role in pain management at a variety of different levels. Psychiatrists:

• Are specialists and generalists when it comes to pain management because they deal with specific consequences and comorbidities—such as depression or anxiety—that patients with pain experience
• Offer a systems’ view of a patient’s rehabilitation and how that patient can remain functional
• Deal with the whole person, the people in their lives, the activities that they’re trying to remain productive in, and how to overcome the barriers to functioning better
• Offer insights into medication management for conditions like neuropathic pain; so many of the medicines are also psychotropic medicines used for other purposes, like depression or mood stabilization
• Look at the problems that they may encounter with medications like opioids or benzodiazepines, making that distinction between who may have an addiction or have