I read with interest Dr. Henry A. Nasrallah’s perspective on the difficulties psychiatry has had in “Integrating psychiatry with other medical specialties” (From the Editor, Current Psychiatry, September 2010, p. 14-15). Dr. Nasrallah highlighted the “geographic separation” of psychiatric practice locations as a main barrier to integration. I strongly agree, but the geographic separation applies not only to practicing psychiatrists but also to trainees. I recently attended a lecture for psychiatrists on how to better collaborate and communicate with other physicians. I left the lecture contemplating why psychiatrists needed this lecture when communication with other physicians is an inherent part of medical practice for most physicians.
Changing the culture of poor communication must start with psychiatry training from the first day of residency. Trainees in other medical specialties work side by side, forming relationships that lend themselves to increased communication, referrals, and curbside consultation. Because psychiatry residents often train in separate locations, they might not work with physicians from other specialties. They might meet very few physicians of other specialties during training, and as a result fewer collaborative relationships are formed. This may contribute to psychiatrists’ decreased willingness to call other physicians to discuss patients or ask clinical questions. In contrast, most primary care physicians know clinicians in subspecialties who they refer to or call with a question. It seems that many of these physicians do not have that same familiarity with psychiatrists, which may further contribute to the perception that our specialty is “different.” Collaborative care models have been effective in mental health treatment in primary care settings,1,2 but implementation outside of research settings has been limited.3 Any attempt at integration is more likely to be sustainable if it also involves implementing changes during training that encourage career-long patterns of communication with our colleagues across specialties.
Rachel Weir, MD
Clinical Assistant Professor of Psychiatry
University of Utah
Salt Lake City, UT
1. Unützer J, Katon W, Callahan CM, et al. For the IMPACT Investigators (Improving Mood-Promoting Access to Collaborative Treatment). Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA. 2002;288(22):2836-2845.
2. Roy-Byrne P, Craske M, Sullivan G, et al. Delivery of evidence-based treatment for multiple anxiety disorders in primary care: a randomized controlled trial. JAMA. 2010;303(19):1921-1928.
3. Meredith LS, Mendel P, Pearson M, et al. Implementation and maintenance of quality improvement for treating depression in primary care. Psychiatr Serv. 2006;57:48-55.