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Psychiatric cases: an ethnography of the referral process

Published online by Cambridge University Press:  09 July 2009

David Morgan*
Affiliation:
Health Services Research Unit, University of Kent, Canterbury
*
1Address for correspondence: David Morgan, Keynes College, The University of Kent, Canterbury CT2 7NP.

Synopsis

Investigation into the referral histories of a consecutive series of new patients attending two psychiatric out-patient clinics questioned the assumption that only the more severe and problematic cases are selected by general practitioners for specialist referral. In 40% of cases, clinical indications only became decisive in relation to emergent difficulties in managing the case, while 38% of patients or their relatives requested referral. The implications of these observations are considered in relation to alternative models of psychiatric intervention in the management of psychosocial disorders in primary care.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 1989

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References

Brook, A. (1978). An aspect of community mental health: consultative work with general practice teams. Health Trends 10, 3739.Google Scholar
Brown, G. W. & Harris, T. (1978). The Social Origins of Depression. Tavistock Publications: London.Google ScholarPubMed
Brown, R. M. A., Strathdee, G., Christie-Brown, J. R. W & Robinson, P. H. (1988). A comparison of referrals to primary care and hospital outpatient clinics. British Journal of Psychiatry. 153, 168173.CrossRefGoogle Scholar
Carey, K. & Kogan, S. (1971). Explanation of factors influencing physician decisions to refer patients to the mental health service. Medical Care 9, 5566.CrossRefGoogle Scholar
Fink, R., Shapiro, S. & Goldensohn, S. (1970). Family physician referrals for the consultation and patient initiation in seeking care. Social Science and Medicine 4, 273291.CrossRefGoogle Scholar
Fink, R., Shapiro, S., Goldensohn, S. & Daily, E. (1969). The filter-down process to psychotherapy in a group practice medical care program. American Journal of Public Health 59, 245260.CrossRefGoogle Scholar
Ford, C. V. (1983). The Somastizing Disorders Illness as a Way of Life. Elsevier Biomedical: New York.Google Scholar
Forsyth, G. & Logan, R. (1968). Gateway or Dividing Line? A study of Hospital Outpatients in the 1960s. Oxford University Press: LondonGoogle Scholar
Gardiner, A., Petersen, J. & Hall, D. (1974) A survey of general practitioner's referrals to a psychiatric outpatient service. British Journal of Psychiatry. 124, 536541.CrossRefGoogle Scholar
Gask, L., McGrath, G., Goldberg, D. P. & Millar, T. (1987). Improving the psychiatric skills of the experienced family doctor.Paper presented at the Seattle Research Conference on Mental Disorders in General Health Care Settings.Google Scholar
Goldberg, D. & Huxley, P. (1980). Mental Illness in the Community. Tavistock Publications: London.Google Scholar
Goldberg, D., Steele, J. J., Smith, C., & Spivey, L. (1980). Training family doctors to recognise psychiatric illness with increased accuracy. Lancet ii, 521.CrossRefGoogle Scholar
Hopkins, P. & Cooper, B. (1969). Psychiatric referral from a general practice. British Journal of Psychiatry 115, 11631174.CrossRefGoogle ScholarPubMed
Horder, J. (1983). Psychiatric training for future general practitioners. The Practitioner 227, 1375.Google ScholarPubMed
Ingham, J., Rawnsley, K. & Hughes, D. (1972). Psychiatric disorder and its declaration in contrasting areas of South Wales. Psychological Medicine 2, 281292.CrossRefGoogle ScholarPubMed
Johnson, D. A. W. (1973 a). An analysis of outpatient sevices. British Journal of Psychiatry 122, 301306.CrossRefGoogle Scholar
Johnson, D. A. W. (1973 b). A further study of psychiatric outpatient services in Manchester British Journal of Psychiatry 123, 185191.CrossRefGoogle ScholarPubMed
Kaeser, A. & Cooper, B. (1971). The psychiatric patient, the general practitioner and the out-patient clinic: an operational study and a review. Psychological Medicine 1, 312325.CrossRefGoogle Scholar
Kessel, N. (1963). Who ought to see a psychiatrist? Lancet i, 10921095.CrossRefGoogle Scholar
Marks, J.Goldberg, D. P. & Hillier, V. F. (1979). Determinants of the ability of general practitioners to detect psychiatric illness. Psychological Medicine 9, 337353.CrossRefGoogle ScholarPubMed
Mendel, W. M. & Rapport, S. (1969). Determinants of the decision for psychiatric hospitalisation. Archives of General Psychiatry 20, 321328.CrossRefGoogle Scholar
Ministry of Health (1963). The Field of Work of the Family Doctor Report of the Sub-Committee of the Standing Medical Advisory Committee. HMSO: London.Google Scholar
Morgan, D. (1978). Factors affecting the identification and treatment of psychiatric disorders in primary care. Health Services Research Unit, University of Kent.Google Scholar
Pullen, I. & Yellowlees, A. J. (1985). Is communication improving between general practitioners and psychiatrists? British Medical Journal 290, 3133.CrossRefGoogle ScholarPubMed
Robertson, N. C. (1979). Variations in referral patterns to the psychiatric services by general practitioners. Psychological Medicine 9, 355364.CrossRefGoogle Scholar
Shepherd, M., Cooper, B., Brown, A. C. & Kalton, G. (1966). Psychiatric Illness in General Practice Oxford University Press: London.Google Scholar
Smith, R. C. (1985). A clinical approach to the somatising patient. Journal of Family Practice 21, 294301.Google Scholar
Strathdee, G. & Williams, P. (1984). A survey of psychiatrists in primary care: the silent growth of a new service. Journal of the Royal College of General Practitioners 34, 615618.Google ScholarPubMed
Tyrer, P. (1984). Psychiatric clinics in general practice. An extension of community care. British Journal of Psychiatry 145, 914.CrossRefGoogle ScholarPubMed
Williams, P. (1979). The interface between psychiatry and general practice. Smith, Klein & French Publications 2, 112.Google Scholar
Williams, P. & Wallace, B. (1974). General practitioners and psychiatrists – do they communicate? British Medical Journal, i, 505507.CrossRefGoogle Scholar