Medicine for the marginalised? All doctors should be taught and tested
Editor - Richard Smith drew attention to the mismatch between the
health needs of people with learning disabilities and the response of the
medical profession (1). "Unfortunately those who care for marginalised
groups
themselves become marginalised".
Recruitment to Psychiatry of Learning Disability has always been low,
except in parts of the country with dynamic, research-oriented leaders.
Despite the high level of skill required to practise psychiatry with
patients who have communication problems, and despite the scope for
research, the status of the specialty is not high.
So how to proceed? I doubt if young doctors would flock to choose a career
which Smith says is staffed by "people, often inspired by religious
faith... willing to devote themselves..." and "others... who cannot find
places in the more popular parts of medicine and who drift reluctantly...".
These extremes of career choice exist, but most Specialist Registrars in
Psychiatry of Learning Disability report (2) that the main determinant of
their career choice was their experience of high-quality SHO training
during a psychiatry rotational training scheme. Young doctors rarely
consider a career in the specialty until they discover how rewarding it is
to develop skills (especially in communication) that few other doctors
have.
My vision of what is needed is that all doctors should have good quality
teaching on delivering general medical care to people with learning
disabilities. All Royal Colleges should test the competence of doctors to
deliver medical care in each specialty to people with learning
disabilities. Candidates for postgraduate exams should expect to fail if
they are unable to demonstrate competence in their specialty with patients
with learning disabilities. This would require all medical schools and all
Royal Colleges to teach and test these skills.
Dr Neill Simpson, PhD, MB, ChB, MRCPsych, MSc, Cert Health Econ, Cert
MHS
Secretary, Faculty of Psychiatry of Learning Disability, Royal College of
Psychiatrists
1 Smith R. Medicine and the marginalised. British Medical Journal, 1999,
319, 1589-1590
2 Carvill S., Marston G., Hollins S. "Tell me what you want, what you
really, really want!". Trainee attitudes within the Faculty of Psychiatry
of Learning Disability. Psychiatric Bulletin, 1998.
Rapid Response:
Medicine for the marginalised? All doctors should be taught and tested
Editor - Richard Smith drew attention to the mismatch between the
health needs of people with learning disabilities and the response of the
medical profession (1). "Unfortunately those who care for marginalised
groups
themselves become marginalised".
Recruitment to Psychiatry of Learning Disability has always been low,
except in parts of the country with dynamic, research-oriented leaders.
Despite the high level of skill required to practise psychiatry with
patients who have communication problems, and despite the scope for
research, the status of the specialty is not high.
So how to proceed? I doubt if young doctors would flock to choose a career
which Smith says is staffed by "people, often inspired by religious
faith... willing to devote themselves..." and "others... who cannot find
places in the more popular parts of medicine and who drift reluctantly...".
These extremes of career choice exist, but most Specialist Registrars in
Psychiatry of Learning Disability report (2) that the main determinant of
their career choice was their experience of high-quality SHO training
during a psychiatry rotational training scheme. Young doctors rarely
consider a career in the specialty until they discover how rewarding it is
to develop skills (especially in communication) that few other doctors
have.
My vision of what is needed is that all doctors should have good quality
teaching on delivering general medical care to people with learning
disabilities. All Royal Colleges should test the competence of doctors to
deliver medical care in each specialty to people with learning
disabilities. Candidates for postgraduate exams should expect to fail if
they are unable to demonstrate competence in their specialty with patients
with learning disabilities. This would require all medical schools and all
Royal Colleges to teach and test these skills.
Dr Neill Simpson, PhD, MB, ChB, MRCPsych, MSc, Cert Health Econ, Cert
MHS
Secretary, Faculty of Psychiatry of Learning Disability, Royal College of
Psychiatrists
Consultant Psychiatrist, Borders Primary Care NHS Trust, Melrose,
Roxburghshire TD6 9HR
References
1 Smith R. Medicine and the marginalised. British Medical Journal, 1999,
319, 1589-1590
2 Carvill S., Marston G., Hollins S. "Tell me what you want, what you
really, really want!". Trainee attitudes within the Faculty of Psychiatry
of Learning Disability. Psychiatric Bulletin, 1998.
Competing interests: No competing interests