Medical and surgical inpatients who referred themselves for psychiatric consultation are characterized. The 25 "self-referred" compared to 787 "others" referred to the Consultation-Liaison Psychiatry Division were more likely to state depression ( 52% 25%) and anxiety ( 36% 11%) as reasons for referral. "Self-referrals" were less likely to be referred by physicians for behavior management ( 8% 23%), general diagnosis ( 4% 22%) or suicide evaluation ( 4% 25%). The "self-referral" represents a challenge to the current medical model referral mechanism in which the physician controls access to consultants. The data indicate that there should be a mechanism for the patient's contribution to the referral process and that increased sensitivity to psychologic difficulties in coping with medical illness would improve the use of psychiatric consultation in the medical setting.