Commentary: psychiatry and primary care.

The role of the psychiatrist in educating primary care physicians has evolved from one of leadership to that of weakened collaboration. Concurrently, other mental health professionals compete with the psychiatric physician for actual clinical referrals. The primary care physician's fear of loss of control, stigmatization from psychiatric labels, and issues of time and money are reasons cited for limiting psychiatric intervention. Although the consultation-liaison service has proved to be a useful vehicle for integrating psychiatric services in hospital settings, how best to integrate psychiatric education and service in the ambulatory-based practice is still a challenge. Issues of clinical uncertainty and medical responsibility that the primary care provider regularly experiences may offer solutions for reestablishing the psychiatric physician as the leader in such educational and clinical initiatives.