CONSULTATION-LIAISON PSYCHIATRY FELLOWSHIP IN PRIMARY-CARE

Objective: This article describes the need for and development of an o utpatient primary care psychiatry fellowship program. Method: The Depa rtment of Psychiatry at Hillside Hospital established a primary care f ellowship for psychiatrists in 1994, through its consultation-liaison (C-L) service. Staff alliances established by the C-L service with pri mary care physicians provided the basis for identifying appropriate ou tpatient practices in the community. Knowledge and skills objectives w ere adapted from a traditional C-L fellowship to outpatient primary ca re medicine. Results: The selection of a psychologically minded primar y care practitioners was crucial. Practitioners used an inclusive mode l in which fellows would see all patients with them, not just those wi th mental disorders. Fellows have felt comfortable working in the prim ary care setting and have been well received by practitioners, staff, and patients. The practitioners were clearly more interested in psycho social aspects of their patient than were primary care residents. Conc lusions: The gap in preparing U.S. psychiatrists to function in integr ated primary care programs requires establishing a presence in the pri mary care setting. Skills and relationships from traditional C-L setti ngs can be productively used to accomplish this goal.