The understanding and management of psychological problems and psychiatric disorders by primary-care physicians

Objective: As primary-care physicians play a very important role in detecting and treating mental disorders, the different conceptions of psychiatry they might endorse and their interest in psychiatry need to be examined. Method: The data come from a survey, carried out in Geneva, Switzerland, among physicians on the psychiatric knowledge and skills which a non-psychiatric physician should have. The main conceptions of psychiatry were extracted by factorial analysis. Results: The three main conceptions of psychiatry fostered by primary-care physicians are the psychosocial, the clinicalbiological and the psychodynam c conceptions. The psychosocial conception encompasses the complex and long-lasting problems having social implications for the patient and effects on the physician-patient relationship. The clinical-biological understanding of psychiatry emphasizes the importance of differential diagnosis, treatment and medication. These two conceptions are mainly favored by general practitioners and general internists. Physicians fostering these conceptions consider that they have among their patients a higher percentage of people suffering from psychiatric or existential problems. The third approach, psychodynamic, is principally endorsed by pediatricians; these physicians refer a higher number of their patients to psychiatrists. One-fifth of primary-care physicians can be considered as having a particularly great interest in psychiatry. Comparison with non primary-care physicians indicates that the latter are less oriented towards psychiatry. Conclusions: These data show the importance of the training of primary-care physicians in different areas of psychiatry. Further research would be necessary to delineate the type of relationship that primary-care physicians have with psychiatrists (competition, delegation or cooperation) according to their conception of psychiatry.