The use of the physical examination as a diagnostic tool for the recognition of organic factors in mental disorders is not the only reason to concern oneself with physical diagnosis. As psychiatrists, we often see patients who lack the social skills and material resources to obtain adequate general medical care. Such patients have a substantial rate of significant general medical disorders.12 We need to ensure their access to proper care, not only by advocacy and social work measures but also by functioning as physicians, even if the disorders in question are incidental to the psychiatric illness (in the sense that they are not causing organic psychopathology).
Furthermore, we may make our patients sick with the medicines we prescribe. The current, justified concern over the metabolic effects of psychotropic drugs in itself should force reconsideration of the appropriate general medical role of the psychiatrist. The metabolic syndrome has had several definitions; its elements are listed in Table 2. Consensus guidelines for management of patients taking atypical antipsychotic agents now call for frequent measurement of weight, blood pressure, and waist circumference.13 How the implementation of such recommendations will affect the process of care in general psychiatry deserves thought.14 A practice set up to meet these needs might feature the psychiatrist in a rather different position from what is now customary.