Collaborator
Collaborator
The Collaborator domain tests teamwork: referrals, liaison, handover, role clarity, and managing disagreement without losing the patient's safety.
Core rules
- Define the question before referral: Is this delirium? Is the patient safe for surgery? Can this antidepressant be used with tramadol? Vague referrals waste time and lose marks.
- Use structured handover (SBAR: situation, background, assessment, recommendation) and close the loop.
- In consultation-liaison psychiatry, assess the physical team's concern, the patient's capacity, drug interactions, and risk; give practical recommendations and a follow-up plan.
- Clarify roles in the multidisciplinary team: nursing observations, psychology formulation, social work placement, pharmacy interactions, OT function.
- Document shared decisions and dissent. If you disagree with a colleague, state the clinical concern, evidence, and escalation route.
- Work with families, interpreters, police, and Mental Health Review Boards within confidentiality limits.
Worked example
A 70-year-old postoperative patient is confused and pulling out lines. The surgical team asks for sedation. Reasoning: first exclude hypoxia, sepsis, urinary retention, constipation, pain, and drug withdrawal. Recommend non-pharmacological measures, review anticholinergics, and use low-dose antipsychotic only if needed, with QTc and extrapyramidal monitoring. Communicate this verbally and in the notes, and arrange review. The answer is not haloperidol alone.
Traps
- Referring without a question and assuming the referral is complete.
- Criticising the team in notes instead of resolving the issue.
- Prescribing for delirium without examining the patient.
- Losing role clarity so two teams each assume the other is monitoring.