0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Letter to the Editor   |    
Psychiatry and General Practitioners
ARTHUR RIFKIN, M.D.; WILLIAM DAVID RIFKIN, M.D.
Am J Psychiatry 2005;162:1026-1026. doi:10.1176/appi.ajp.162.5.1026

To the Editor: Frederick S. Sierles, M.D., et al. (1) showed that future psychiatrists score higher than other medical students on measures of psychiatric knowledge and verbal reasoning and lower on other topics. They then concluded that more attention should be paid to the general medical education of psychiatrists. We question how the authors interpreted their data. The scores on the measures of learning were standardized. Therefore, if some people do better, then some must do worse. Given this obvious situation, isn’t it better for future surgeons to perform above the mean on surgical subjects, future internists in general medicine, and future psychiatrists in psychiatry? Much, if not all, of the differences in Medical College Admission Test and U.S. Medical Licensing Examinations scores most likely can be attributed to student preferences and interests at baseline and the clinical content of the first postgraduate year.

The public health consequences and likelihood of making medical errors because of poor training are different for psychiatrists and nonpsychiatrists. About 20% of the patients seeing primary care physicians have a significant mental disorder (2). Only 23% of the patients with depression treated by primary care physicians received an antidepressant, of whom many receive an insufficient dose (3, 4). Missed psychiatric diagnoses and undertreatment of those properly diagnosed by a primary care physician are serious problems. Is the converse true for psychiatrists? This has not been shown. Most psychiatric patients, we would imagine, have been evaluated and are treated by primary care physicians for any general medical condition before they see or are referred to a psychiatrist. Psychiatrists should advise a patient who has not been seen recently by a primary care physician to do so. Psychiatric patients routinely see primary care physicians; patients seeing primary care physicians do not routinely see psychiatrists. It seems to us that the urgent need is not for future psychiatrists to learn more general medicine but for future primary care physicians to learn more psychiatry.

Sierles FS, Vergare MJ, Hojat M, Gonnella JS: Academic performance of psychiatrists compared to other specialists before, during, and after medical school. Am J Psychiatry  2004; 161:1477–1482
[PubMed]
[CrossRef]
 
Olfson M, Fireman B, Weissman MM, Leon AC, Sheehan DV, Kathol RG, Hoven C, Farber L: Mental disorders and disability among patients in a primary care group practice. Am J Psychiatry  1997; 154:1734–1740
[PubMed]
 
Wells KB, Katon W, Rogers B, Camp P: Use of minor tranquilizers and antidepressant medications by depressed outpatients: results from the Medical Outcomes Study. Am J Psychiatry  1994; 151:694–700
[PubMed]
 
Simon GE, Von Korff M, Wagner EH, Barlow W: Patterns of antidepressant use in community practice. Gen Hosp Psychiatry  1993; 15:399–408
[PubMed]
[CrossRef]
 
+

References

Sierles FS, Vergare MJ, Hojat M, Gonnella JS: Academic performance of psychiatrists compared to other specialists before, during, and after medical school. Am J Psychiatry  2004; 161:1477–1482
[PubMed]
[CrossRef]
 
Olfson M, Fireman B, Weissman MM, Leon AC, Sheehan DV, Kathol RG, Hoven C, Farber L: Mental disorders and disability among patients in a primary care group practice. Am J Psychiatry  1997; 154:1734–1740
[PubMed]
 
Wells KB, Katon W, Rogers B, Camp P: Use of minor tranquilizers and antidepressant medications by depressed outpatients: results from the Medical Outcomes Study. Am J Psychiatry  1994; 151:694–700
[PubMed]
 
Simon GE, Von Korff M, Wagner EH, Barlow W: Patterns of antidepressant use in community practice. Gen Hosp Psychiatry  1993; 15:399–408
[PubMed]
[CrossRef]
 
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Books
DSM-5™ Clinical Cases > Chapter 17.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 47.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 24.  >
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 12.  >
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 12.  >
Topic Collections
Psychiatric News
APA Guidelines