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If all of that work-up is unremarkable, the emergency department team may consider a psychiatry consultation if the hospital has psychiatrists on staff.

In addition to interviewing and examining the patient, a psychiatrist would review the patient’s chart and any available electronic records from other facilities for background information. If family or friends are available, psychiatrists try to speak with them. And psychiatric teams try to get in touch with previous providers or anyone else who might add insight to the situation. From start to finish, these evaluations can take hours.

Today, patients usually do not get admitted to psychiatric units just for saying, “I’m hearing voices.” To be hospitalized, patients need to have symptoms of a psychiatric disorder – such as hearing voices, suffering from depression and feeling suicidal – that are so profound as to cause safety concerns or significant impairments in daily living, such as dysfunction at work or home. If the patient were admitted to a psychiatric unit and then suddenly stopped having symptoms, it would be difficult to justify keeping that person on the unit. Insurance would stop paying for the hospitalization. Every day, physicians have to document why someone needs be treated in a hospital rather than in an outpatient setting.

Rosenhan’s findings may come across to hospital leaders as something that “could never have happened in my hospital,” and Rosenhan addressed this criticism in his original paper. The staff at one teaching hospital apparently heard about his study and believed that they would not make similar mistakes with pseudopatients. According to Rosenhan, he challenged them to spot pseudopatients that he would send to their hospital. The staff later claimed with a high degree of confidence to have identified 41 pseudopatients – then Rosenhan revealed that he had not sent any at all.