In the history of medicine, the consultation is an old and honored function, participated in by two or more members of the profession with the idea of assistance, exchange of information, and the passing from one to the other of advice gained from special knowledge and experience. In the past, it has been a matter of honorable recognition that certain teachers and elders of the profession have been approached by their younger colleagues to assist them in special problems relating to diagnosis or planning of a treatment regimen. It has been a form of teaching and a form of friendly assistance. The increase of knowledge concerning the great mass of medical information and the growth of specialties and subspecialties has expanded the need for consultation generally throughout the profession.The word "consultation" is, of course, used to express a number of different functions. When it refers to the meeting of physician and patient, it frequently assumes the meaning of the treatment process. The consulting rooms are the places where the physician meets a patient and takes care of him. The phrase "consultation by appointment" also usually refers to the meeting of the physician and the patient in regular diagnostic and treat¬ ment procedures.In this paper, the word "consultation" is specifically restricted to the following definition: "the request for an opinion concerning diagnosis and advice concerning treatment, and not referral for treatment." The consulta¬ tion implies that the advice concerning a diagnosis and treatment shall be given to the physician in charge of the case, who, in most instances, will proceed to carry out the advice of the more learned consultant. The plan for treat¬ ment, of course, may involve specialized hospitalization and the selection of a hospital or specialized treatment, which the referring physician may not be able to carryout. An attempt is made to differentiate between the assistance in diagnosing and planning for treatment and the actual carrying out of the treatment itself.
MODERN PSYCHIATRYIn the field of psychiatry, one is dealing with a problem that, though old as antiquity, nevertheless has only re¬ cently become a distinct and separate branch of medi¬ cine. Psychiatry is encumbered with the burden of vast clinical needs, vast institutionalism, and insufficient knowledge concerning etiology and specific treatment. This is mitigated by great progress in treatment in more generalized ways. The specialty suffers from difficulties of measurement, both of the quality and quantity of its symptomatology and pathological processes. The relationship between what can be seen and what can be deduced from observations makes it a far more difficult field in which to work than others in which well-known measuring devices, technical instruments, laboratory pro¬ cedures, and, particularly, the microscope and the roent¬ gen ray assist the general observation and deduction processes.The scope of psychiatry has grown from a relatively narrow, limited area of concentration to an interest in every ...