Sir: I appreciate Dr. Manning's careful reading of my article. I agree that the diagnosis of bipolar disorder is difficult not only for primary care providers but also for psychiatrists. Only a controlled random-assignment study can determine which specialty accomplishes diagnosis and management better. I also agree that competent clinicians should always practice within the boundaries of “training, experience, and proven ability.”
Parenthetically, what data on “proven ability” is Dr. Manning referring to?
Finally, I applaud the sentiment that he welcomes a time when “psychiatry and primary care integrate into a seamless delivery system.” In fact, in my opinion, psychiatrists are going through a major shift in their roles from a core identity as “psychodynamic psychotherapist” in the 1960s to “biological psychopharmacologist” in the 1990s to “primary care plus psychiatric caregivers” in the new millennium.
Footnotes
Dr. Glick has been a consultant for, received grant/research support from, and participated in speakers/advisory boards for Bristol-Myers Squibb, Eli Lilly, Pfizer, AstraZeneca, and Janssen and is a major stock shareholder in Johnson & Johnson and Forest.