Wednesday, June 06, 2012

Psychiatry is a medical speciality

I've been thinking about the motivation for the move to a remedicalised psychiatry, which I've mentioned several times previously (eg. see previous post). What psychiatrists are worried about is that their job seems to be being taken over by non-medical professionals.

I gave up my medical training for 8 years because I found it difficult to see the need for medical training in psychiatry. However confused this decision was, it does mean I am speaking from experience on this matter.

We should welcome other professionals taking on consultant roles, including being responsible clinicians under the Mental Health Act. However limited in practice this development has been so far, it is happening in other areas of medicine besides psychiatry. It offers more choice to a patient to be able to see a consultant from another profession, such as nursing or clinical psychology. Other professions should be encouraged to take on the responsibility which has traditionally been undertaken by the doctor.

Other professionals have always had a central role in managing patients in hospital. This continues to be the case with care co-ordination in the community.

None of this means that medical training is not of value for psychiatry. This is because many physical complaints have a psychogenic origin. In fact, as argued by Bill Fulford and others, psychiatry could be seen as the pre-eminent medical speciality because practice is so obviously determined by values. This may be more hidden in the rest of medicine but a focus on the person is inevitably central.

In particular , none of this justifies retreat into a biomedical psychiatry. In fact, it was the disease-centred nature of biomedicine that put me off understanding the medical nature of psychiatry when I was younger.


George Dawson, MD, DFAPA said...

I shudder to think of what would have happened to many of my patients if I could not have diagnosed their medical illnesses. The reason I could do that was not because I had superior diagnostic skills than their specialist, but because I could communicate better and understand what was happening to them better. Most people don't realize how much medical illness is missed due to that communication problem. I would not see that as a retreat. I see a psychiatrists job as making a determination what part of the persons presentation is due to something other than a mental health problem.

I have been doing it for over 25 years.

Altostrata said...

I agree, the danger to patients is medical conditions misdiagnosed and treated as psychiatric, while the medical condition deteriorates.

But here in the US, psychiatrists are not displaying any particular acumen for distinguishing medical conditions; they make exactly the same mistakes.

I truly wish psychiatry could make an argument for greater effectiveness and safety in treatment, but that would require putting high value on patient safety, which it steadfastly refuses to address. Instead, its engaged in protecting territory and, if possible, expanding it.

George Dawson, MD, DFAPA said...

I disagree that psychiatry is engaged in "protecting territory". Anyone familiar with the managed care environment in the US for the last 20 years recognizes that psychiatry has been disproportionately rationed by these companies and the government. Access to psychiatry and all mental health professionals has been limited by these mechanisms and political influence of American psychiatry is practically nil.

On the other hand there are excellent guidelines on the medical evaluation of psychiatric patients available in books, journals and through professional organizations. I taught one course myself for 20 years and worked on a staff that was highly skilled in the medical assessment of psychiatric problems.

Anonymous said...

the average communication skills I encounter in psychiatrist's offices would make you shudder.

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