Respect From Our Medical Colleagues

To the Editor: As a consultation-liaison psychiatrist, I read with great interest Dr. Gorman’s eloquent description of the end-of-life comanagement of an elderly patient with his medical colleagues. Dr. Gorman’s experience will certainly resonate with psychiatrists who work intensively with medically ill patients who have comorbid psychiatric disorders. One troubling aspect of this and many similar cases that Dr. Gorman did not address is the readiness with which many of our nonpsychiatric medical colleagues attribute critical somatic symptoms to patients’ psychiatric disorders. This can occur despite intensive psychiatric consultation with recommendations for further medical evaluation and treatment. I have seen patients die because their psychiatric disorder was viewed as the etiology of their somatic symptoms.

Do psychiatrists really have too much respect from their colleagues? Until we do, and as long as bias toward our patients and our profession exists, psychiatrists must continue to advocate for their patients in the health care system. In addition, we need to take every opportunity to educate colleagues, residents, and medical students in the diagnosis and treatment of comorbid medical and psychiatric disorders.