Psychiatry and the Role of the General Practitioner

Abstract

The psychiatric role of the general practitioner covers a wide field and depends crucially upon his efforts to understand himself, his patient, and the doctor-patient relationship. The patient must be approached in terms of how he is affected emotionally by physical illness, and how his state of physical health is affected by his emotions. His behavior during initial stages of physical illness, his reaction to the diagnosis, and his feelings and interactions during the full-blown stages of illness are important areas for the doctor to explore in order to deal more effectively with a patient's withdrawal, depression, narcissism, frustration, or anxiety. The doctor must also explore his own motivations for choosing the medical profession in order to implement his role in caring for patients. Each of the models of the doctor-patient relationship–activity-passivity, guidance-cooperation, mutual participation-requires different degrees of emotional involvement on the part of the doctor. An understanding of the psychodynamics of this relationship, involving the attitudes and conflicts of both members, can help the general practitioner to handle effectively and successfully his patients in everyday practice. Practical suggestions are made for teaching psychological concepts to general physicians: improved courses in psychiatry in medical schools, emphasizing the “whole person” approach; ongoing seminars for doctors in practice–“Balint Groups”–in which the aim is to understand the nature of the patient's emotional conflicts, the doctor-patient relationship, and the part the doctor plays in it; refresher courses; and consultations with psychiatrists.