On those days when my ego is barely in control of my id, I often reach the conclusion that nonpsychiatric physicians simply don't know enough medicine. This may sound ironic from one whose speciality receives the very same criticism—and often with justification.1 And yet, the experience of the psychiatric consultant in a busy university hospital tends to confirm my impression. The medicine that is "unknown" to many internists, emergency physicians, and other nonpsychiatrists is the medicine that relates to psychiatric patients. One sees this deficit in the many requests for psychiatric consultations in the absence of any reasonable attempt to rule out organic pathology. Thus, Johnson2 showed that one half to one third of referring physicians are using psychiatry as a primary care resource, often neglecting to take histories or perform physical examinations.
One can reasonably argue that psychiatrists ought to embrace the medical model and even perform
Pies R. A Medical Status Exam. JAMA. 1981;245(20):2081. doi:10.1001/jama.1981.03310450061028
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