General practitioners' attitudes to psychiatric and medical illness

Background. General practitioners are increasingly involved in the care: of patients with long-term psychiatric disorders. We have previously reported that general practitioners are less willing to treat patients with schizop hrenia than those without such a diagnosis, but this may have been attribut able to a reluctance to treat patients with any psychiatric or chronic illn ess. We, therefore, examined general practitioners' attitudes to patients w ith chronic psychiatric or medical illnesses. Methods. A random sample of 260 local general practitioners were each sent one of our case vignettes which were identical apart from mention of a prev ious diagnosis of schizophrenia, depression, diabetes or no illness. The ge neral practitioners were asked to indicate their level of agreement with 13 attitudinal statements based on the vignette. Results. One hundred and sixty-six (66%) of the general practitioners respo nded to the case vignettes. Those responding to the vignette about the pati ent with schizophrenia were less happy to have that patient on their practi ce list and were more concerned about the risk of violence and the child's welfare. Those responding to the depression vignette were more likely to of fer the patient antidepressants or counselling; and those who replied to th e diabetes case were most likely to refer the patient to a hospital special ist. These differences were not attributable to the personal or practice ch aracteristics of the general practitioners. Conclusions. Patients with schizophrenia arouse concerns in general practit ioners that are not simply due to those patients suffering from a psychiatr ic or chronic illness. Our results suggest that some patients with schizoph renia may find it difficult to register with a general practitioner and rec eive the integrated community-based health care service they require. Psych iatrists should provide education and support to general practitioners who look after patients with schizophrenia.