Interview with Simona Tamasan

2009, Simona Tamasan, liaison psychiatrist

Since a few years psychiatrist Simona Tamasan is responsible for starting the consultative psychiatric service at Timisoara County Emergency Hospital. Her job is internationally known as Liaison Psychiatry. This specialization is very important for a general hospital, because a lot of misery can be prevented when a combination of psychiatric illness with physical illnesses is recognized early and the expertise of a psychiatrist can be called upon. Psychiatric liaison consultation has good evidence for cost-effectiveness in the health systems. Simona has been working in this hospital, which has more than thousand beds and covers the western part of the province, for seven years now. At first her assistance was requested only whenever a patient became unmanageable because of psychiatric problems.

‘Medical doctors had not been trained to pay much of attention to someone’s mental state or psychological condition. It can be also a matter of time constraints in medical profession. Anyway, in recent years they begin to realize the importance of such problems. This is a part of my role. Initially I was prudent, they were curious. What kind of benefit I could provide to the patient? Slowly a relationship grew. Liaison means connection, so that’s what I try to establish.’

Psychiatrists always have to fight for their position in relation to the more traditionally settled specialists. You are fighting on the forefront as long as the liaison psychiatrist is relatively unknown in Romania.

‘Yes, I think I gained a lot by negotiating with the settled doctors. The psychosocial aspect in the medical model, that’s what I fight for. In the general hospital we are physically closer, they don’t have to decide to call a psychiatrist from the special psychiatric clinic elsewhere. They can approach me and we discuss about the case. When you are just around in the same hospital it is easier to call you in.’

Can you give an example?

‘When a 32 year old woman suffers from repetitive headaches an emergency specialist has to exclude several diagnosis, even a brain tumor, whereas a psychiatrist will sooner notice her being stressful and ask her about her social circumstances. A few questions about her daily life can make clear that the headache is less probable to come from a brain tumour – is a somatoform expression of the underlying stress. In this way you can prevent panic and intrusive examinations, and try to find her suitable help.’

Are you often called in at the Emergency Room?

‘Usually at the stage of triage. That’s when a decision is made about what to do with a patient for whom, for instance in case of a panic attack, the medical situation is not clear. People react with anxiety when they don’t know what is happening to them. And the unknown can make one less cooperative. Another aspect of liaison psychiatry is that we can talk with the caregivers. We have an important role with psychotic inpatients. In the first place we can help the medical staff to handle a frequent rejecting attitude to those patients.’

The psychiatrist can be the translator between the psychotic patient and the medical specialist?

‘Yes, translator or mediator. Chronic psychiatric patients are often physically fragile or can suffer from the effects of medication. Medical science pays more and more attention to the metabolic syndrome. Schizophrenia and the medication against it can disturb a fragile balance. When medication is prescribed it is important to know how to weigh benefit versus risk and try to manage this.’

A patient who uses psychopharmaca can be seriously upset if he is required to stop his medication before an operation.

‘Yes, that’s the point. There can be unmanageable or dangerous sideeffects. Psychiatrists are aware of this and can help to prevent it.’ The combination of psychiatric problems with other illnesses is always complicated. ‘You have to listen and exchange information as much as you possibly can’ says Simona Tamasan. ‘You have to be very dedicated.’