Ronald Rosenberg

A crisis often provides an opportunity for change in a patient, according to Ronald Rosenberg, MD.The crisis situation mitigates denial, avoidance, and rigidity, said Rosenberg, associate director for inpatient psychiatric services, North Shore University Hospital, Manhasset, NY.

Patients may have been taken forcibly to PES by police, family, or an ambulance.Space and privacy are limited there.Physicians are rushed.But encounters still can be therapeutic, he maintained.

Tuning in to the patient's emotional reactions, Rosenberg said, can help ease frustration, calm agitation, and encourage patients to talk about their concerns.Physicians should attend to immediate needs: the patient may be hungry or thirsty.One can offer choices"Would you like this chair or that one?"and show empathy"This has been a hard day for you."One should strive to build an alliance before asking necessary questions that may upset the patient or sound trivial: "Have you been in jail?Can you spell 'world' backwards?"

The notion of restoring equilibrium, offering a hungry patient a sandwich, for example, Rosenberg said, is not a psychiatric model, it's a consumer model.The physician offers help, the patient sees that, and more often cooperates with treatment.

COMORBIDITY COMMON