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Harold Bursztajn, MD; Arthur J. Barsky, MD

Arch Intern Med. 1985;145(1):73-75.

Abstract
• There are five common ways in which a patient may object to a physician's suggestion of a psychiatric referral. The patient may reject the referral because of the social stigma of being a psychiatric patient; because the referral damages his or her self-esteem; because the patient does not understand the role of emotions in physical discomfort; because the patient feels rejected by the referring physician; or because of the effects of psychiatric illness. Following a thorough medical workup, the physician can best discharge his or her responsibility to the patient by paying attention to these possible misunderstandings. The physician can discuss the role of social stigma, offset the blows to the patient's self-esteem, educate the patient about the psychosomatic model of disease, and assure the patient of the physician's continuing interest and involvement.

(Arch Intern Med 1985;145:73-75)

Author Affiliations
From the Program in Psychiatry and the Law, Department of Psychiatry, Massachusetts Mental Health Center (Dr Bursztajn); the Psychiatry Service and Primary Care Program, Massachusetts General Hospital (Dr Barsky); and the Department of Psychiatry, Harvard Medical School (Drs Bursztajn and Barsky), Boston.

Footnotes
Accepted for publication June 11, 1984.

Reprint requests to Program in Psychiatry and the Law, Department of Psychiatry, Massachusetts Mental Health Center, 74 Fenwood Rd, Boston, MA 02115 (Dr Bursztajn).

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