Psychiatric consultation in the family physician's office. Advantages and hidden benefits

Family physicians spend up to 40% of their time dealing with emotional and psychiatric problems and may be the only caretaker for 60% of all episodes of psychiatric illness. One way of strengthening the role of the family physician in managing psychiatric problems in their practices is by involving them in an initial psychiatric assessment, which may entail the patient being seen in the primary care setting. This intervention, offered by a community mental health center (CMHC) in Ontario, Canada, was evaluated by examining all cases referred by family physicians over a 3-year period and comparing those seen in consultation in family physicians offices with those seen in consultation in the CMHC. While the office consultation appears to be a cost-effective intervention, the main factor that determined whether it took place appeared to be the attitude of the referring physician rather than the nature of presenting problem. Other benefits arising from such a liaison-consultation relationship are also discussed.