Wake-up call for British psychiatry: responses

Craddock et al ¹ present a compelling argument for retaining the biomedical model of psychiatric illness, while acknowledging that evidence-based psychosocial interventions do have an important place in management and treatment.

It is their discussion about New Ways of Working that particularly struck a chord with me. As a third-year specialist registrar who will soon be looking for consultant jobs, I find myself in a dilemma: am I for New Ways of Working or against it?

Case-loads of 300 patients seen briefly in 15-min ‘routine’ outpatient clinics; one urgent appointment after another; the community team, day unit and GPs all wanting their patients to be seen only by the consultant; ² shouldering responsibility for patients not seen or advised on by me; to me, all of this sounds like a certain recipe for early burnout. Is it any surprise that I do not want any of this?

On the other hand, my medical training has taught me to diagnose and treat appropriately and I do this well. When other members of the team ask me to see someone who they think may have depression, my training enables me to not only exclude depression but to pick up the drowsiness, slurred speech and small pupils of morphine addiction, and to then manage the patient appropriately. As Craddock et al point out, having a broad-based assessment by a doctor at the first point of contact is likely to ensure that the patient gets the most appropriate treatment.

Craddock et al think we should be arguing for better resources and increased workforce. This is very reasonable but is it realistic?

Is the choice, then, between one's personal well-being and that of one's patients? I have not found the answer to this dilemma yet. It is reassuring to see that experienced psychiatrists have strong views on both sides, illustrated by the heated debate over the past few months. Perhaps I should sit on the fence just a little while longer. ³