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Toward Defining the Scope of Psychosomatic Medicine Practice: Psychosomatic Medicine in an Outpatient, Tertiary-Care Practice Setting

Received December 11, 2006; revised February 26, 2007; accepted March 16, 2007. From the Dept. of Psychiatry, Mayo Clinic, Oronoco, MN. Send correspondence and reprint requests to James R. Rundell, M.D., Dept. of Psychiatry, Mayo Clinic, 990 Riverwood Lane SW, Oronoco, MN 55960. e-mail: rundell.james{at}mayo.edu
© 2008 The Academy of Psychosomatic Medicine

BACKGROUND: Because psychosomatic medicine (PM) is increasingly practiced in outpatient settings, the scope of practice needs to be delineated from community psychiatry and inpatient psychiatry work. OBJECTIVE: The authors sought to address the question of whether outpatient activities are a definably part the scope of practice of PM. METHOD: Three clinical groups were compared: 200 PM outpatients, 200 consultation–liaison (CL) inpatients, and 200 community-psychiatry (CP) outpatients. RESULTS: The groups differed significantly in 49 of 112 demographic and clinical comparisons (43.8%). Analysis of individual measures validated the concept that PM outpatient practice requires traditional PM/CL expertise with medical-psychiatric differential diagnosis, unexplained physical symptoms, pain, and psychopharmacological management in medically ill and geriatric patients. CONCLUSION: Outpatient PM experiences may also enhance training opportunities, given an expanded case-mix.

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