Christopher Gordon

An Approach to Collaborative Care and Consultation: Interviewing, Cultural Competence, and Enhancing Rapport and Adherence

Although changes in the US health care system promote a population-based approach, increases in population diversity emphasize the need for culturally competent, patient-centered, participatory care. Despite this perceived conflict, the global view has improved the recognition of mental health issues as a driver of overall health as well as health care spending. This recognition, along with the many forces that keep mental health care in the primary care sector, actually encourages the development of collaborative models that capitalize on the primary care providers opportunity to leverage their rapport with the patient to improve access to, and comfort with, specialty mental health services. Engaging patients in their own path to recovery or well-being improves engagement in, and adherence to, the treatment plan and ultimately improves outcomes.

Emergency ward management of the borderline patient

Abstract The authors discuss assessment and management of the borderline patient in a general hospital emergency ward. Effective clinical intervention depends on rapid diagnosis of the personality disorder, understanding its core psychodynamic issues, and recognizing the impact of the emergency ward environment on the patients behavior. The authors describe three aspects of psychological management: empathic reassurance, borderline crisis intervention, and education. Guidelines for the use of medications, physical restraint, and means of arriving at an appropriate disposition are presented.