Social and structural factors affecting psychiatric consultation in the ambulatory medical setting

The kinds of help primary care physicians requested from a psychiatric consultant in an ambulatory medical clinic are described. Based upon data from 173 encounters involving fifty-four physicians over a five and one-half month period, no single issue characterized a majority of encounters, and the nature of the help requested was diverse. Female physicians were more likely to initiate encounters that dealt with personal feelings about themselves or their patients. Male physicians were more likely to ask for assistance in evaluating patients. Whether or not a patient was seen as part of the consultation also significantly influenced the type of interaction that ensued as did the location of the interaction (hallway, room, or telephone) and whether or not the interaction was planned. Implications of these findings with regard to the training of primary care psychiatrists as well as the use of their services in ambulatory medical settings are explored.