The General Practitioner's Attitude to Psychiatry

Reasons against referral to the psychiatrist

“…This suggests that older consultants are less likely to recognize psychiatric disorder in their patients, which agrees with the finding of Mowbray et al (1961) that younger general practitioners identify more psychiatric patients than their older colleagues. That only 19°/ were prevented from referral by the belief that the treatment of neurotic illness was the job of any doctor makes recognition and-treatment of psychiatric illness without referral an unlikely cause of the discrepancy.…”

Child Guidance and the General Practitioner

“…However, closely similar findings have been reported in general practice studies in adult psychiatry. Mowbray et al (1961) found that diagnosis was relatively unimportant in deciding for or against psychiatric referral. Kessel (1963), reviewing the reasons which influence G.P.s' decisions, concluded: "Not diagnosis, not clinical severity, not failure of treatment are their reasons.…”

“…Numerous estimates of referral rates have indicated that the proportion of adult "cases" referred to psychiatrists is not more than a tenth of the total identified (Kessel, 1960;Rawnsley and Loudon, 1962;Shepherd et al, 1966), The determinants of referral have been extensively studied in general practice, but they have proved complex and difficult to disentangle. It has become clear that "the processes by which people obtain it (psychiatric treatment) are devious and often arbitrary" (Kessel, 1963), Examples of some factors which have been put forward as influential are the patient's age and duration of illness (Shepherd et al, 1966), abnormalities of conduct (Mowbray et al, 1961), pressure from the patient's relatives (Rawnsley and Loudon, 1962;Richards, 1960), distance of the doctor's surgery from the clinic (Hare, 1965), failure of treatment prescribed by the G,P, (Richards, 1960), the age, experience, and attitudes of the G,P, (Cooper, 1964;Mowbray et al, 1961;Rawnsley and Loudon, 1962),…”

The Doctor, His Illnesss and the Patient

“…In discussing the difficulty which patients may experience as a result of being refused referral to a psychiatrist, Mowbray et al (1961) found that one in three of all referrals in a particular area was made at the initiative of the relative of the patient and not by the doctor on clinical grounds. This situation was also found in another part of Britain where neither the clinical diagnosis, its severity, age, civil status or occupation of the patients were found to have the most importance in referral, but social factors and doctors' attitudes were the prime factors (Rawnsley and Loudon, 1962).…”