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Am J Psychiatry 1996; 153:1398-1403
Copyright © 1996 by American Psychiatric Association
Psychiatry at a crossroad: our role in primary care
JH Shore
Department of Psychiatry, University of Colorado Health Sciences Center, Denver 80262, USA.
OBJECTIVE: The shortage of primary care physicians is seen as an urgent
health systems priority and is supported by a national consensus.
Psychiatry is at a crossroad and must reevaluate the profession's role in
primary care. This article supports the position that psychiatrists need to
be able to medically evaluate and to provide basic primary medical care for
seriously mentally ill patients who do not have adequate access to general
health care. Many of the seriously mentally ill are difficult to treat when
they contact a medical care provider. Because of their psychiatric
symptoms, they often are unlikely to receive adequate medical care.
Psychiatrists frequently are the only physicians with whom they have
consistent contact. METHOD: This article contains a proposal for a new
initiative to broaden the role of public psychiatrists to include a primary
care role. In addition, new opportunities for dual or triple board
certification are reviewed. RESULTS: A new curricular model for primary
care training in general psychiatry programs is outlined. The new
curriculum would include training for diagnostic and primary care skills to
prepare psychiatrists to provide basic primary medical services for the
chronically mentally ill. CONCLUSIONS: The new curricular proposal would
create an elective psychiatry primary care track. This is possible within
current accreditation requirements. Psychiatric residents could receive
primary care training throughout their residency.
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