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  • Title: Contemporary issues in obstetrics and gynecology for the consultation-liaison psychiatrist.
    Author: Stotland NL.
    Journal: Hosp Community Psychiatry; 1985 Oct; 36(10):1102-8. PubMed ID: 4054867.
    Abstract:
    Medical advances in obstetrics and gynecology, combined with the depersonalization of health care and changes in sexual and reproductive behaviors in the general population, lead to challenging new problems for the psychiatric consultant who deals with reproductive issues. The author describes contemporary issues encountered in consultation-liaison work with the obstetrics and gynecology service in a general hospital. They include the reproductive implications of medical illnesses, the stress of deciding whether to continue a pregnancy known to carry genetic risk, the intrusiveness of certain options for dealing with infertility, parental expectations for a perfect baby, and the difficulties some traditional practitioners have in adapting their practice styles to the changing needs of the patient population. This paper describes contemporary issues a psychiatric consultant encounters in consultation-liaison work with the obstetrics and gynecology service in a general hospital. They include the reproductive implications of medical illnesses, the stress of deciding to continue a pregnancy known to carry genetic risk, the intrusiveness of certain options for dealing with infertility, parental expectations for a perfect baby, and the difficulties some traditional practitioners experience in adapting their practice styles to the changing needs of the patient population. The paper is based on the author's experience and special interest in psychosomatic obstetrics and gynecology on consultation-liaison services of 2 large university-affiliated general hospitals in Chicago. At this time numerous social, technological, and medical factors are shaping the practice of obstetrics and gynecology, and they are influencing the issues and problems for which psychiatric expertise is indicated. The array of reproductive styles practiced and accepted in American culture has widened greatly. Economic and sociological factors affecting the practice of medicine also influence requests for psychiatric consultation on reproductive matters. With increasing subspecialization in medicine, group prepaid medical care, and geographic mobility, patients are less likely to be cared for by physicians who know them well, and these physicians may more readily request consultation when facing problems with psychiatric implications. Additionally, fear of legal complications may lead practitioners to seek psychiatric consultation about a patient's ability to give consent for treatment in cases in which informed consent would not have been a concern in the past. In no other field has there been such an outcry against the paternalism of physicians as in the field of obstetrics/gynecology and such a wealth of "self-help" activity. And, these changes are frustrating and perplexing to many traditional practitioners. The consultation-liaison psychiatrist encounters many cases in which reproductive issues are not presented as the reason for the consultation request but must be confronted to clarify the current clinical situation or to prevent psychiatric complications in the near or distant future. As the knowledge of genetics expands, increasing numbers of prospective parents make use of genetic counseling or screening. Because mental health professionals may be involved in this process, they need to know something about the new developments in the field. Recently developed treatments for infertility add new dimensions to the psychological management of this condition. 2 case examples illustrate some medical and psychiatric aspects of advances in reproductive microsurgery. The current range of reproductive styles brings some patients for psychiatric consultation about whether to become pregnant.
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