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Compliance With Psychiatric Consultant's Recommendations

Alan Kramer, MD; James Spikes, MD; James J. Strain, MD
Arch Gen Psychiatry. 1980;37(9):1082. doi:10.1001/archpsyc.1980.01780220120014.
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To the Editor.—  The article by Popkin et al in the Archives (36:386-389, 1979) raises an important question to those of us who do psychiatric consultations. If our colleagues do not follow our recommendations to a significant degree, how can this be remedied to improve the effectiveness of our consultations? Not only may the psychiatrist be wasting his time in many of these cases, but the patient is deprived of treatment that may improve his condition, and the primary physician is left without a solution to the problem that prompted him to ask for a consultation.In the course of evaluating certain aspects of a liaison-consultation service by chart audit,1 we found that of 55 recommendations involving psychotropic medications, ten (18.2%) were disregarded. This is consistent with the 24% nonconcordance rate found by Popkin et al. Other types of standard recommendations were also examined. Seven of 24 (29.2%) recommendations for


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