Wake-up call for British psychiatry

Department of Psychological Medicine, Medical School, Cardiff University, Heath Park, Cardiff, UK.
The British Journal of Psychiatry (Impact Factor: 7.99). 08/2008; 193(1):6-9. DOI: 10.1192/bjp.bp.108.053561
Source: PubMed


The recent drive within the UK National Health Service to improve psychosocial care for people with mental illness is both understandable and welcome: evidence-based psychological and social interventions are extremely important in managing psychiatric illness. Nevertheless, the accompanying downgrading of medical aspects of care has resulted in services that often are better suited to offering non-specific psychosocial support, rather than thorough, broad-based diagnostic assessment leading to specific treatments to optimise well-being and functioning. In part, these changes have been politically driven, but they could not have occurred without the collusion, or at least the acquiescence, of psychiatrists. This creeping devaluation of medicine disadvantages patients and is very damaging to both the standing and the understanding of psychiatry in the minds of the public, fellow professionals and the medical students who will be responsible for the specialty's future. On the 200th birthday of psychiatry, it is fitting to reconsider the specialty's core values and renew efforts to use psychiatric skills for the maximum benefit of patients.

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    • "As professionals with medical training, psychiatrists should be directly involved in screening all referrals and conducting initial assessments . This calls for a rethinking of current psychiatric training, clinical practice and service models to enable comprehensive diagnostic assessments with formulation of aetiology and diagnosis followed by specific treatments (Craddock et al., 2008). The assessment should include a cognitive , physical and neurological examination ; we recommend a low threshold for early serological testing for antibodies against NMDAR and the VGKC complex. "

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    • "There is a growing concern in psychiatry about the poor rates of recruitment into the specialty.[101112] There is no doubt that medical students’ educational experience of psychiatry plays a great role in determining whether they choose a career in psychiatry.[13] "
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    ABSTRACT: Psychiatry is not considered important by most medical students. But knowledge of psychiatry is essential for all doctors as psychiatric problems are prevalent in the population either as part of other physical illnesses or independently. All medical practitioners need skills in communication and forming empathy and the ability to counsel that are learnt in psychiatry. Nearly all medical students feel psychiatry is not scientific enough and psychiatrists are peculiar. We need to make psychiatry interesting, and impart skills and techniques to practice psychiatry at the primary care level and in the process change the misconceptions students have of psychiatry. We present a model to accomplish this.
    No preview · Article · Mar 2013 · Indian Journal of Psychological Medicine
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    • "These initiatives, mostly targeted at medical students, have principally aimed to emphasise the biopsychosocial model in psychiatry, and have highlighted how psychiatry is one of a number of professions contributing to the care of psychiatric patients.20 In contrast, a group of mostly academic psychiatrists24 recently called for more emphasis on the medical model in the teaching of psychiatry, and argued that this would contribute to improving the number and quality of candidates for psychiatry training. Commentators have suggested that a lack of emphasis on medical models has fuelled perceptions that psychiatry may not have enough medical content to be attractive to many doctors.25 "
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    ABSTRACT: BACKGROUND: Recruitment of adequate numbers of doctors to psychiatry is difficult. AIMS: To report on career choice for psychiatry, comparing intending psychiatrists with doctors who chose other clinical careers. METHOD: Questionnaire studies of all newly qualified doctors from all UK medical schools in 12 qualification years between 1974 and 2009 (33 974 respondent doctors). RESULTS: One, three and five years after graduation, 4-5% of doctors specified psychiatry as their first choice of future career. This was largely unchanged across the 35 years. Comparing intending psychiatrists with doctors who chose other careers, factors with a greater influence on psychiatrists' choice included their experience of the subject at medical school, self-appraisal of their own skills, and inclinations before medical school. In a substudy of doctors who initially considered but then did not pursue specialty choices, 72% of those who did not pursue psychiatry gave 'job content' as their reason compared with 33% of doctors who considered but did not pursue other specialties. Historically, more women than men have chosen psychiatry, but the gap has closed over the past decade. CONCLUSIONS: Junior doctors' views about psychiatry as a possible career range from high levels of enthusiasm to antipathy, and are more polarised than views about other specialties. Shortening of working hours and improvements to working practices in other hospital-based specialties in the UK may have reduced the relative attractiveness of psychiatry to women doctors. The extent to which views of newly qualified doctors about psychiatry can be modified by medical school education, and by greater exposure to psychiatry during student and early postgraduate years, needs investigation.
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