ABSTRACT
In the UK, G. Strathdee and P. Williams have shown that psychiatrists are progressively extending their extramural services into the community, most often by conducting out-patient clinics in local health centres and group practices. The ‘shifted out-patients’ model implies simply that the psychiatrist moves the locus of his out-patient activities from the hospital clinic to the primary-care setting, whilst keeping his mode of work largely unchanged. Most cases of psychiatric illness are encountered in the primary-care setting, but many of them are not recognized by the doctors. Doctors with high identification indices were rated by an independent observer as having greater interest in, and concern for, the individual patient, being more interested in psychiatry, and being more experienced in patient management; they were also somewhat older than the average. Some patients fail to express their psychological distress at consultation and present exclusively somatic complaints.
