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Medical Patients: Consultation and Psychotherapy

ROGER F. SPENCER, MD
Arch Gen Psychiatry. 1964;10(3):270-275. doi:10.1001/archpsyc.1964.01720210052008.
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Introduction  Psychiatrists in consultative practice encounter patients under a wide variety of circumstances and often must reach decisions on limited evidence. A deft touch is called for, and little opportunity usually exists for confirmation or refutation of initial impressions. An increased understanding of this type of psychiatric practice and its problems may be gained, therefore, by study along two dimensions. These are: (a) measurements of the validity and reliability of brief clinical impressions, and (b) follow-up study of patients' dispositions following consultation.A preliminary survey of the disposition of patients seen in consultation by the Liaison Service* showed that a very high proportion of patients was being recommended for psychotherapy by the resident consultants, while most of the rest were advised to return to their local physician for "support" or pharmacotherapy. Hospitalization was advised for some. It seemed that very few patients were availing themselves of the recommended psychotherapy, and

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