Primary care and psychiatry: anticipating an interfaith marriage

The emergence of a managed-care--driven health delivery system in the United States has had a major impact on both primary care physicians and psychiatrists. Since a significant portion of psychiatric disorders present in primary care settings and a significant number of patients with emotional disorders receive their care from primary care physicians, the convergence of the two fields of medicine seems likely. Surveys document that both the diagnosis and the treatment of emotional disorders are inadequate in primary care. The authors review possible approaches to rectifying this situation and show that the attachment of the psychiatrist to the primary care team offers many advantages to the provision of clinical services, the education of a diverse group of trainees, and the collaboration of two categories of physician not typically seen as working closely together. The authors also describe an outpatient county medical clinic in which the concept of "attachment-liaison" of the psychiatrist to the primary care setting is tested on a daily basis. The authors (a psychiatrist and an internist), who met in this setting, detail their initial expectations and the observed outcomes of having a psychiatrist join the clinic team. The various tasks of the psychiatrist in this primary care setting are enumerated, along with several typical case presentations.