Approach to the patient in primary care psychiatry

International studies suggest that 30% of patients who are seen in the primary care setting have a diagnosable psychiatric disorder, and that an equal number suffer from significant psychological distress that warrants careful follow-up. ¹ Many studies have focused on the under-recognition and under-treatment of patients with psychological disorders in primary care practice throughout the world. Contributing factors are reported to include physician-related factors, such as deficient skills in interview and diagnosis, competing clinical priorities leading to preferential focus on physical problems, and the lack of available resources for treatment and follow-up. Other factors have not been well researched, but may be particularly relevant in the Arab world. These may include perceptions that the physician maintains patient dignity and allows them to save face if the diagnosis of a “shameful” condition such as depression is concealed. ²