The tradition of medical practice is based on the assumption that the patients come to the doctor for professional advice and service. Having done so, they have the right to reject the advice or refuse the service, and to go elsewhere. There are a few exceptions to this general rule. Children do not come to doctors, they are brought to them. In that case, the rights pertain to the parents. Persons who are so seriously injured or ill that they cannot exercise their judgement, will be brought for treatment, and it is then assumed that the doctors will use their professional judgement and do their best, considering the circumstances, for them. This applied also to those patients who were mentally disturbed in such a way that they could not make proper decisions.

In 1966, Sir Aubrey Lewis retired from the Maudsley Hospital. To mark the occasion, the postgraduate students at the Bethlem Royal and Maudsley Hospitals published a selection of his writings, which appeared in 1967. But the flow of papers from his pen continued unabated until his death in 1975. Michael Shepherd was thus enabled to bring out a further volume in 1979, containing some of these later papers'.

A previous paper in this series with the same title (Lipowski, 1979) described the history and recent developments in the organisation of consultation liaison psychiatry. I therefore cover two other aspects, the nature of the psychological reactions to physical illness and the clinical role of the psychiatrist working on general surgical and medical wards. Lipowski remarked on the “generally mediocre quality of research” and on the lack of a “single fully adequate textbook”. These deficiencies remain all too apparent and the increasingly large literature is still mainly “clinical and anecdotal”. However straightforward clinical descriptions do provide an essential background to understanding the practical impact on patients' and families' lives of illnesses and of their treatment. A good knowledge of medicine is also essential and the liaison psychiatrist requires an up to date textbook and should try and read review papers and editorials in the general medical journals.

Over the last 30 years the proportion of those over 65 in our population has increased by nearly 50 per cent. Over the same period alcohol consumption in general has risen by nearly 100 per cent, probably with an even greater increase in those suffering from alcohol-related problems. Nevertheless, many doctors still do not expect to find alcohol abuse in elderly people.