Teaching psychological diagnosis and management

Teaching experiences have been described which illustrate the medical student's tendency to isolate what is learned in psychiatry from clinical work in general medicine. This tendency can be minimized by presenting diagnosis as the complete assessment of a patient, rather than exclusively as a search for disease. Early experience in patient care helps the student broaden his or her concept of clinical assessment. An important goal of psychiatric teaching in medical school is to help students learn to evaluate the psychological status of the general medical patient. Attention is focused upon this evaluation by use of the problem-orientated record. Since the data base is derived largely from the medical history, objectives for the interview are presented in detail. Students are encouraged to consider the relations between the patient's psychological status and other aspects of the medical problems. Only after they have learned to make evaluations of general medical patients, are the psychiatric syndromes introduced. An example is presented of a programme in which psychiatric teaching is carried out in a surgical ward of a general hospital. Success of such programmes depends upon explicit description of goals and methods, and upon collaboration with colleagues in other departments who share similar goals.