Mental and Neurological illnesses
20 June 2012
White and colleagues1 lament the dichotomy between mental and neurological illnesses and blame the classificatory systems for this. However, it is possible that the psychiatrists might have estranged themselves from the rest of medicine.
The mental health services have broken away completely from the mainstream medicine. Their training, funding, organisation of services and provision of services are all separate and different from the rest of healthcare in the UK.
The UK is one of the very few countries in the world where one can become a fully qualified psychiatrist without having any postgraduate experience in neurology or any other medical specialties. In many countries, trainees learn psychiatry and neurology together in their initial years and choose their specialty towards the end of their training. Moreover, in many countries many disorders such are epilepsy are managed by psychiatrists and not neurologists.
Medical students’ career preferences are often influenced by their placement experience. I asked 40 medical students to rank their career choices before and after their 4th year, the year in which they had their psychiatry placement. Compared to all other specialties psychiatry had the greatest drop in preference ranking following placement in the specialty. Perhaps there is some scope for psychiatry to present a more welcoming and positive perspective.
Psychiatrists are the only health care professionals who, despite having no evidence base, claim to be able to predict, modify and control people’s future behaviour and accept blame when their predictions go wrong and/or their preventive measures don’t work e.g. when their patients commit self harm, suicide or homicide. No other medical professional including neurologists would accept blame if one of their patients who is massively obese, hypertensive and diabetic, who smokes and drinks heavily and does not follow medical advice and who had a number of cerebrovascular incidents dies months from a stroke after a consultation with them.
Doctors occasionally treat patients who are too unwell to know that they are unwell. However, in order to start treating such a patient, even if the psychiatrist has known the patient for years, the psychiatrist has to convince a social worker, and in order to continue treatment, the psychiatrist has to convince a legal professional and a lay person, none of whom are medically qualified, and get their blessings.
Thus, many of the practises of psychiatrists are alien to the rest of the medical profession. The best step towards integrating psychiatry and the rest of medicine would be for psychiatrists to start training and behaving like the rest of their medical colleagues. Changing classificatory systems and policies won’t achieve this.
1 White PD, Rikards H, Zeman AZJ. Time to end distinction between mental and neurological illnesses. BMJ 2012; 344:3454.
Competing interests: None declared
Lincoln County Hospital, Lincoln
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