Beyond liaison: a future role for psychiatry in medicine

Integrated biopsychosocial treatment is necessary for medical patients in whom psychosocial and behavioral issues strongly influence medical outcome. In this article the authors identify several large groups of such patients, and point out the limitations of three established approaches to improving their care: psychosocial education for non-psychiatrists, traditional consultation-liaison psychiatry, and 'behavioral medicine.' They present reasons why many of these patients would best be served by having psychiatrists as their primary physicians. Primary care of selected medical patients by psychiatrists is feasible and would improve patient care, interspecialty communication, reimbursement, and recruitment of psychiatric residents.