A research agenda for outpatient consultation-liaison psychiatry

Primary care settings are increasingly important sites for psychiatric research. A broader range of many psychiatric disorders is encountered here than in the mental health arena, and their study will therefore provide us with a more representative picture of the true nature of these disorders. This is also the setting in which to investigate the medical care process itself, including such phenomena as nonadherence with the medical regimen, patient delay before seeking appropriate medical attention, the placebo phenomenon, patient satisfaction, and the nature of the doctor-patient relationship. Much of primary care practice consists of the management and palliation of somatic symptoms, yet the phenomenology of somatic symptoms has barely been investigated. Outpatient psychiatric researchers are in an ideal position to study the entire process of symptom perception, formation, experience, and reporting, including the phenomenon of somatization. However, ambulatory medical settings impose particular constraints and demands upon consultation-liaison researchers. They may be met with indifference and even suspicion, and in turn they too often fail to appreciate the nature of the primary care setting and the research questions that are important to primary care providers, whose interest and involvement must be enlisted from the outset. Consultation-liaison researchers must acquire the substantive skills, knowledge, and techniques that are demanded by this type of research, because this work must be rigorous and of high caliber.