Psychiatric decision making in family practice. Future research directions.

Psychiatric illnesses in family practice are significantly underdiagnosed because of factors associated with both the physician and patient. Clinicians too often fail to utilize a biopsychosocial approach in the assessment process, tending to assess symptoms as organic regardless of their etiology. Patients similarly tend to emphasize the physical nature of their complaints when presenting in medical settings. Efforts have been made to improve the physician's diagnostic accuracy through the use of screening scores. The results, however, are inconclusive. It remains unclear whether the physician disregards this information or considers it irrelevant. We suggest that future research investigate not only the accuracy of the clinician's diagnostic formulation but also the processes whereby the family practitioner elicits, analyzes, and synthesizes or discards cues pertinent to mental illness. By combining statistical analyses with the analytic techniques developed in studies of medical decision making and general problem solving, detailed leads should emerge for the design of improved didactic and experiential training programs.