Maurice H. Greenhill
THE THRUST for the psychological care of the sick came from psychiatry rather than from medicine. It was part of a strenuous effort by psychiatry to gain a share of the practice of medicine. How this was done and at what expenditure of effort will be described in this presentation. But psychiatry has been so eager to be accepted as a discipline by medicine, that it seems at times to have lost sight of the patient as the primary concern of psychological care. The goal of liaison psychiatry is the biopsychosocial care of the medically ill patient, but so many obstacles to this have arisen that efforts to persuade members of the hospital power base (nonpsychiatrist physicians and administrators) to acknowledge the value of psychiatric methods have often taken precedence over patient care itself. 58 This proselytizing effort has been going on since 1929 74 and has led to the development of a specialty —liaison psychiatry.
Throughout its history, the locus of liaison psychiatry has been the general hospital. Here geographical fact and the presence of the patient in residence facilitates transactions between medical disciplines. There has been relatively little experience with liaison programs for ambulatory or home care patients. In community hospitals, psychiatric consultation systems alone may be standard; in tertiary hospitals a variety of consultative‐ liaison programs exist depending on the characteristics of the hospital. Their function, success, or failure depends largely on the liaison psychiatrist, whether he is a consultative psychiatrist in private practice, a full-time hospital physician, or a psychosomatic fellow. His effectiveness depends largely on the strategies he has devised to overcome the obstacles inherent in the health system. For the liaison psychiatrist, these obstacles are legion; in no other area of medicine are there so many.58,110,134 They include functioning in clinical territories over which he has little authority and working with physicians who give little credence to