De psychiater als medisch specialist: De psychiatrie een zorg?

In the Netherlands, in the last decennia the medical identity of the psychiatrist has been caving in. In the beginning of the eighties, consultation-liaison psychiatry and specific functions for patients with a combination of psychiatric and physical disease (co-morbidity) in general hospital psychiatric units seemed an opportunity to counteract this phenomenon. The last ten years, the government policy to integrate the field of mental health by introducing the multifunctional units resulted in aforced movement of the psychiatric units out of the general hospital. A development, which has been insufficient counteracted by a strategy of the Dutch Psychiatric Association (Nederlandse Vereniging voor Psychiatrie). The increase of chronic illness and of elderly results in an increase of co-morbidity. As the further development of psychiatry as a medical specialty stopped, psychiatrists working on the interface feel impeded and patients are wronged. A top priority for psychiatry should be a powerful stimulus of the field of general hospital psychiatry (including consultation-liaison psychiatry), treatment programs for co-morbid patients and psych-med units to maintain a link with the other medical specialties. The currently discussed combined year of training as a start for all medical specialists trainings might offer an additional opportunity in this respect.