Abstract
This paper reports the author's experience in the private practice of psychiatry in Halifax—a city of 100,000 people from 1941 to 1961. Such a population provides an adequate work load, both in numbers and variety. Many demands will be made on the psychiatrist in this kind of situation, not ordinarily thought of as clinical psychiatry. He will be a community adviser in many fields. Basically, though, he is a doctor and should act as one with regard to medical ethics and custom, as well as taking his share of responsibility for diagnosis and therapy. If he mixes with his fellow practitioners medically and socially, he will be accepted by them as any other doctor is. Careful but understandable reports to referring doctors are of great value in educating his colleagues in psychiatric ways. Many patients will be returned to these colleagues for treatment, but the consultant should be readily available for advice and support. This kind of practice will demand an eclectic approach with a readiness to improvise and compromise.
In the author's opinion, electro-convulsive therapy has been the most important advance in psychiatric practice during this period. It has been astonishingly successful in relieving much human suffering and in improving community attitudes to mental health problems and to psychiatric practitioners and psychiatric patients.
This kind of practice can be afforded financially by most patients and can be covered by pre-paid medical schemes. The private community practice of psychiatry allows excellent opportunity for follow-up, develops exceedingly strong doctor-patient relationships, and gives human satisfactions to the practitioner far in excess of the financial reward. Experience indicates that the private practitioner of psychiatry, living in a community and being part of that community, provides a most important community mental health resource.