Mental Health and Family Medicine: between Scylla and Charybdis

Background: Since 1999 the Romanian health insurance system shifts to a Bismarck model where primary care is provided by family medicine physicians, in private practices, under contract with local insurance houses. Family doctors are supposed to have a Gatekeeping role, ensuring that patients see specialists only for conditions that could not be managed at this level and are referred to an appropriate specialist. Aims: To explore the opinions of the family doctors on the interventions needed for a better management of the psychiatric cases. Method: A survey was conducted among 43 family doctors from Galati county (Romania). Results and Discussion: Despite a formal gatekeeping role, Romanian family doctors do not have a pivotal role in coordinating psychiatric care. Direct access to a specialist is possible for certain pathologies and there is evidence of overuse of ambulance services, hospital services and outpatient care setting bypassing primary care. Conclusion: Rather than focusing on the "gatekeeping" we should focus on more collaborative work between family doctors and psychiatrists with patients. An improved communication and cooperation between the family doctor and the psychiatrist plays an essential role for proper care processes and thus the overall quality of care for the psychiatric patient.