Neal, thirty-two, a long-term patient of mine is concerned about his five-year old daughter who is having behavior problems in kindergarten. He and his wife are told by the school that she is uncooperative at school and that she needs to be ”evaluated.” Neal and Sophie, his wife, take Chelsea, his daughter to Dr. Firth, their highly regarded Westside pediatrician. Dr. Firth, hearing the concerns from the parents, advises Neal and Sophie to take Chelsea to an occupational therapist. The occupational therapist evaluates Chelsea and she tells Neal and Sophie to take Chelsea to an optometrist because she seems to be having “balance issues”. My heart is having palpitations. “Maybe you should consult a child development specialist or a child psychiatrist,” I suggest, hoping that Neal does not feel that I am dismissing Dr. Firth. “Well, I know you see kids,” he says, “but my wife and I associate you with medication and there is no way that we want to put Chelsea on medication.” Again, I pause in distress. “Chelsea needs an evaluation, so it is no way clear whether medication in on the table or not. First thing is first.” I say, reminded that in these days, people only think of child psychiatrists as “medication doctors” and they forget that their expertise is also in assessment. I think about Dr. Firth. Why did he refer Chelsea to an occupational therapist when the report from the teachers was that she was having behavior problems. Should I call the pediatrician and ask him? Of course, I could not do that without both Neal and Sophie’s permission. Why did Dr. Firth not think of referring Chelsea to a child psychiatrist? I really wish I knew the answer to that question. My hunch is that Dr. Firth has a professional relationship with this particular occupational therapist and that he is not aware of the variety of professionals who do mental health assessments for children, even though he is a well established pediatrician. On the one hand, if what I am suspecting is true, it is unbelievable. On the other hand, if what I am suspecting is true, then Child Psychiatrists have done a poor job of marketing their talents. Maybe both are true.