Informal discussions between psychiatric trainees reveal frequent difficulties and frustrations in providing adequate medical care to psychiatric patients. Our writing this article was prompted by the death of a patient who had been referred to casualty with behavioural and physical problems, and who, once labelled as a ‘psychiatric patient, did not receive the medical attention he required. Other trainees will have their own similar examples, at best resulting in only inconvenience to the junior doctor. This may seem surprising given the knowledge that people with psychiatric problems suffer increased physical morbidity. We were all taught as medical students that a physical presentation may mask a psychological problem and vice versa, and that both problems may co-exist. However, this knowledge does not always impinge on hospital clinical practice. From the viewpoint of junior psychiatrists, cross-specialty referral and consultation, and the provision of adequate medical care to our patients can be difficult. In this discussion, we will deal briefly with the contribution of ‘physical’ medicine to this state of affairs and then turn in more detail to the influence of psychiatry. Recommendations for improvement are made.