Academic journal article The Israel Journal of Psychiatry and Related Sciences

Attitude of General Practitioners towards Psychiatric Consultation in Primary Care Clinic

Academic journal article The Israel Journal of Psychiatry and Related Sciences

Attitude of General Practitioners towards Psychiatric Consultation in Primary Care Clinic

Article excerpt

Abstract: Fifty general practitioners (GPs) were surveyed about their attitudes towards psychiatric liaison-consultation services. The questionnaire differentiated among GPs' attitudes towards the liasonconsultation model and towards the various possible roles of the psychiatrist who visits the GP's practice. These attitudes were analyzed in relation to the level of post-graduate training of the GPs, and to their psychological sensitivity as measured by the PMI scale. GPs with specialist registration certificates in family medicine were more interested in working together with psychiatrists and rated themselves as more sensitive to psychological issues. The largest group (39%) among the GPs thought that the main task of the visiting psychiatrist is to advise them on psycho-social issues, while leaving clinical responsibility in their hands. Less frequent responses included: diagnosis and treatment within the primary care clinic (17%), facilitating referrals (15%), and update teaching of psychiatry (12%). The predominant attitude was consistent with the finding that 96% of the GPs thought that they had good abilities at recognizing patients in distress, and 92% rated their doctor-patient relationship skills as high.

Introduction

Psychiatric disorders have been reported as the third most common reason for consultation in primary care, and up to 25% of patients who are seen by general practitioners (GPs) suffer from a psychiatric problem (1,2). Nevertheless, more than half of the patients who suffer from psychiatric disorders do not receive psychiatric treatment (3, 4). Commonly, this is because of the difficulties some GPs have in diagnosing psychiatric problems (5, 6), or because the patients refuse to seek psychiatric help. Of those who eventually do receive psychiatric help, about half are treated by their GP (7), while half are sent to psychiatric clinics for treatment.

The two most commonly used models of collaboration between GPs and psychiatrists are the shifted out-patient clinic model and liaison. In the shifted out-patient clinic (8) a visiting psychiatrist operates a psychiatric clinic inside a community health center. Technically, this enables easy access of the patients to the psychiatrist and saves the need to travel to a psychiatric clinic, which is often located at a distance. This model also partly overcomes the stigma of being treated in a mental health center (9), thus facilitating earlier intervention. In contrast, the liaison model (8,9) is based on a working collaboration of the GP and the psychiatrist and it aims at increasing awareness of the psychiatric elements of various diseases and at guiding the GP as to when to refer a patient for a comprehensive psychiatric consultation (10). The psychiatrist visits the GPs' sessions regularly, and they both examine patients together. Alternatively, the GP might consult the psychiatrist by presenting the case without the psychiatrist actually examining the patient. They discuss diagnosis and treatment, and they decide together on the need for further referral of the patient to various psychiatric facilities. The advantage of case presentations is that the GP can provide professional psychiatric care to patients without referring them to a psychiatrist. This is of great importance in the light of the reports that one-third of patients who are sent by their GPs to psychiatric clinics do not take advantage of the referral (11). In addition, the collaboration utilizes both the GP's and the psychiatrist's knowledge. The main disadvantage of the liaison model is the time that the consultation demands of the GP and the feeling that some GPs might have that the psychiatrist intrudes into their domain (12).

Many studies have described the different consultative models, but little has been written about the attitudes of the GPs towards this collaboration. In England (13), a questionnaire was administered to 1,133 consultant psychiatrists, and it was found that the two patterns of collaboration that were considered to be most effective were assessment by the psychiatrist with treatment conducted by the GP, and assessment and short-term treatment conducted by the psychiatrist. …

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