The continuing tendency to isolation of psychiatry from general medicine, among other things, is related to subtle differences in relationships with and attitudes toward patients. These differences are rooted both in historical developments and in the types of needs posed by typical patient problems. The role of the physician has traditionally been an active authoritarian one well described by the term ego-surrogate. The role of the psychiatrist is typically one of interpreting behavior to the patient but not directing it. Awareness of the differing needs of patients could lead to greater flexibility in both roles. Most importantly, understanding of the other's role would enhance respect and communication.