Consultees’ concordance with consultants’ recommendations for diagnostic action

Consultees’ concordance with psychiatric consultants’ recommendations for diagnostic action was studied retrospectively. Of 381 initial consultations reviewed, 110 (29 per cent) contained one or more recommendations for diagnostic action. Consultees’ responses were rated concordant in only 53 per cent of these cases. This disturbing outcome, reflecting broad resistance to consultants’ practice of making recommendations for diagnostic action, is attributed to consultees’ use of a functional vs. organic dichotomy regarding psychiatric disorder. The functional category is argued to be perceived by consultees as a nonmedical entity. As the psychiatrist is invoked to deal with this nonmedical entity, he is seen in other than the medical mode and inconsistently afforded medical privilege. The work implies how wide the gap to medical credibility may be for psychiatric consultants and the need for new consultation strategies incorporating this cognizance.