Stop bashing psychiatry, royal college urges medical students

Badmouthing of psychiatry by doctors and medical students stigmatises mental ill health and has an impact on medical career choices, the Royal College of Psychiatrists has warned.

The college is launching a campaign to bolster initiatives to expose the negative effects of “bashing” and badmouthing of psychiatry. The BASH campaign will be led through “psych socs,” which make up the largest single group of student societies in medical schools, said Simon Wessely, president of the Royal College of Psychiatrists.

“The current generation of students don’t put up with the things we used to,” Wessely told BMJ Careers. “Derogatory comments about race, sexuality, and gender are not common now, and when they do occur students complain. We want them to become the people who call others out when they denigrate psychiatry and mental health.”

He added, “I remember being told that I would be wasted in psychiatry because I was too smart. What that says is that mentally ill patients only deserve crap doctors.”

By way of an example, Wessely described how a psychiatrist was called to an emergency department to deal with a patient who had overdosed and was announced with the phrase, “Here comes the pest controller.”

“This isn’t about not being able to take a joke,” Wessely emphasised. “We’ve known for a long time that the attitudes of others, including senior doctors, inform students’ career choices. That’s true of all specialties, but it’s particularly true of general practice and psychiatry.”

As part of the campaign, the college will be working with mental health charities and medical school deans to drive home the message that bashing psychiatry is no longer acceptable, and Wessely will be visiting every UK medical school to discuss the issues.

A study published in the college’s journal, the BJPsych Bulletin, found that psychiatry was one of the disciplines that medical students most disrespected.1 The researchers asked students from 13 UK medical schools to rank eight specialties in a hierarchy of perceived respect, according to the disparaging remarks they had heard or witnessed or had themselves made.

The 960 responses to the online survey showed that psychiatry and general practice attracted the greatest number of negative comments from among radiology, surgery, emergency medicine, hospital medicine, obstetrics and gynaecology, and anaesthetics. Comments included “psychiatrists are not actual doctors,” “psychiatrists are crazy themselves,” and “people become GPs when they fail all other exams.”

Most (80.5%) of the survey respondents condemned badmouthing as unprofessional, particularly if done by a senior doctor. But seven in 10 (71.5%) thought it was just part of the job, and more than half (just over 57%) saw it as “harmless banter.”

The students were also asked if disparaging remarks made about particular specialties had put them off. More than a quarter (27%) agreed that they had changed their career choice as a direct result of a specialty’s denigration by others.

Around a third said that they had deliberately kept quiet about their preferred career choice for fear of sparking discrimination among their peers or clinicians during clinical placements. The more senior the student, the more likely they were to have encountered psychiatry bashing, with fifth year students reporting the highest levels.

The researchers pointed out that this might simply reflect the fact that the more senior students had been around longer, “but it could also indicate that this behaviour becomes more ingrained as students progress through medical school,” they wrote.