Psychiatric “Diagnosis”? Or Psychiatric Diagnosis.

Psychiatric “Diagnosis”? Or Psychiatric Diagnosis.
By Dr. Daniel Pistone

Of course the quotes are there for a reason. And it is: who is qualified to make a psychiatric diagnosis?

I say this because it is so very common for patients with emotional problems to be “diagnosed” by non psychiatrist mental health professionals.

And yet: let’s make it clear: Psychiatry is a medical specialty, just like Dermatology, Gynaecology, Oncology, Radiology…

So what does that mean in terms of diagnosis? That psychiatric diagnosis is a Medical diagnosis.

Unfortunately, many professionals who work with patients with emotional and behavioral problems are obligated to give a “diagnosis” by insurance companies for reimbursement purposes. But that is another story. The issue we are discussing here is: are they qualified? And: what about accuracy? My 20 years of active psychiatric practice tell me the numbers are low at best.

There are no, as yet, biological “tests” to make psychiatric diagnoses. The reality is there will not be any for the time to come. So how is a psychiatrist equipped to make diagnosis as a physician whereas other non psychiatrist/physicians mental health clinicians are not? First of all, a Psychiatrist is a graduate from a medical school and an accredited Psychiatric Residency Program. So just like the Neurologist is best equipped to diagnose types of headaches: there is no diagnostic “tests” for headache by the way. But the Neurologist KNOWS headaches so well that he knows how to listen first (the “Chief Complaint”), what questions to ask and how to interpret responses, etc. He can then pin point the type of headache in order to prescribe the treatment; of course he may order especially brain imaging studies, but not to make a diagnosis of headache but in order to rule out, say, a brain mass.

So with the psychiatrist: he knows psychiatric illnesses so well that he knows what to pay attention to, what to ask, what to make of the responses (most of the times); he knows Medical illnesses that can present with emotional and/or behavioral problems. Same for medications that can cause psychiatric problems. He may even run a focused physical and/or neurological examination, order pertinent labs, or imaging studies, and know when to refer to the right specialty

Non psychiatrist mental health professionals have a major role to play in treatment of psychiatric illnesses. I refer many of my patients to therapists/psychologists for treatment before considering medication (depending on the condition and other things).

But when it comes to Psychiatric Diagnosis, make no mistake. Those are Medical Diagnosis.

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Dr. Daniel Pistone, MD,

Dr. Daniel Pistone has been practicing psychiatry for over 20 years. He has worked as a Diplomat for the Argentine Boards of Internal Medicine and Critical Care Medicine and for the American Board of Psychiatry and Neurology . Moreover, he has worked with CMCH, Roseville, CA, Pee Dee Mental Health, Florence, SC(Locum) and Neurology Consultants of the Carolians Research, Charlotte, NC. Recently, he has associated with Savant Care (, a team of mental health professionals, psychiatrists and therapists to help patients recover from their mental disorders and lead a happy life.