Reflections on Psychiatry in the General-Hospital Setting

For psychiatry to be successfully integrated into the general hospital, the psychiatrist must function within the medical model, and his mode of practice must be consistent with general-hospital caretaking. The author discusses the positive effects of consultative and liaison psychiatry linkages in the general-hospital setting as well as the problems of financing; there are inequities of reimbursement for consultation and a lack of payment for liaison services. He makes several suggestions about the education of the psychiatrist; it should not be geared exclusively toward the psychiatrist's role as a primary caretaker. Medical schools should introduce students to the discipline of psychiatry and its interrelationships with other disciplines. Teaching hospitals should train the psychiatrist in the medical model. The author feels that the future of general psychiatry does not lie in primary care per se but in its being an identified specialty closely allied to super-specialists and to primary caretakers alike.