Assessment of Uncooperative Patient (Examination of non-cooperative Patient) Kirby's Proforma

Initial psychiatric assessment of the uncooperative patient can often be quite challenging. It is difficult to fully assess an uncooperative patient. The complete psychiatric evaluation usually cannot be completed until the patient is calm enough to participate in a psychiatric interview. In the absence of any laboratory-based test for diagnosis, an uncooperative patient challenges any health care provider. Nonetheless, emergency clinicians must perform their duty of providing care as soon as the agitated patient presents to an emergency setting. For this reason, the psychiatric evaluation of an uncooperative patient becomes valuable for the same. In this regard Kirby’s proforma plays an important role in providing a semi-structured format in the assessment of uncooperative patients. The focus of the evaluation is on developing a reasonable differential diagnosis, ascertaining safety and self-care concerns, and deciding how to manage the agitation.

Psychiatric evaluation of the agitated patient includes visual observation of the patient before the direct patient interview and paying careful attention to the patient's verbal and nonverbal interaction with the examiner during de-escalation. Collateral information can be very helpful. While de-escalation is in process, another team member can obtain verbal reports from family, paramedics, or police officers or review written material that may accompany the patient.


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