Toward defining the scope of psychosomatic medicine practice: Psychosomatic medicine in an outpatient, tertiary-care practice setting

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.