is the most exciting and fun speciality of medicine'
by Greg Watson
is the most exciting and fun speciality of medicine, the president
of the Royal College of Psychiatrists (RCP) stated yesterday.
Professor Dinesh Bhugra was commenting on a "catastrophic"
situation whereby only one in 10 newly-qualified psychiatrists are
Medical graduates who opt for psychiatry as their career must, during
their six-year training, pass postgraduate RCP exams. This year,
of the 519 candidates who sat the first postgraduate RCP exam sitting,
only 64 (12 per cent) were UK graduates – a record low. The
next sitting is in October.
Last year, incorporating both exam sittings, the totals were 230
UK graduates from 1,043 examinees; in 2007 it was 257 from 1,491,
in 2006 it was 315 from 1,515; and in 2005 it was 388 from 1,372.
The figures highlight the falling competition for psychiatry training
Around 400-500 psychiatry posts have to be filled in the NHS each
year. Most psychiatrists employed from overseas come from India
and West Africa.
government points out that its investment in mental health has resulted
in 64 per cent more consultant psychiatrists compared to 1997.
But in a bid to recruit more UK psychiatrists, Prof Dinesh Bhugra
said: "The message to UK graduates is that this is most exciting
and fun speciality in medicine.
else would you use cinema, theatre, literature, neurosciences, psychology,
sociology and anthropology to pull it all together? But a lot students
and junior doctors are being put off for various reasons."
A Channel 4 report yesterday warned of a shortage of UK psychiatrists
and a significant drop in the quality of trainee psychiatrists.
Prof Robert Howard, dean of the RCP, said: "Catastrophic is
the word I would use for the shortage we are now facing. We have
always struggled to recruit significant numbers but this year is
"It has got to the point where you can count the number of
UK doctors coming into it in tens, when we have hundreds of training
posts to fill.
"The doctors who are coming in from overseas to work in the
UK: some are brilliant, and our president is a shining example.
This is not being racist or unpleasant. But many of them [overseas
doctors] have difficulties with communication and the nuances of
the UK's culture. And if there is a speciality where it is essential
to know the culture, it is psychiatry. There needs to be a balance.
"Overall, because of the lack of competition, we are giving
jobs to some people who are 'appointable' but certainly not people
who it fills our spirits to have given jobs to.
"The fact that we have to make a decision about the minimum
standard cut-off point for potential 'appointability', and that
we feel relieved when we find sufficient people who just scrape
over this is damning enough."
Allan House, professor of liaison psychiatry, University of Leeds,
June 8, 2009
It's all right for Dinesh to say "Where else would you use
cinema, theatre, literature, neurosciences, psychology, sociology
and anthropology to pull it all together?" but the truth is
that for many potential graduates the experience we show them is
endless risk-assessments (courtesy of our mental health tsar), dirty
dangerous wards (courtesy of our government) and the insulting banality
of reducing all of human complexity to a diagnsis of "personality
disorder" (courtesy of most of our profession and the RCP).
a monumental task to reverse this, and it won't be done by mixing
arts with facile psychobabble. It needs "personal and national
politics" in Dinesh's list.
Louise Pembroke, mental health campaigner, London
June 11, 2009
Well said Allan. It is hard to see how trainees/psychiatrists are
allowed to use that wonderful list in practise with their current
looked at a MRCPsych exam - biology-biology-bit of psychology and
more biology - it's little wonder psychiatrists are unable to converse
about the content of people's experiences. [McCabe R, Priebe S,
 Communication and psychosis: it’s good to talk, but
how? British Journal of Psychiatry 192, 404-405, doi; 10. 1192/bjp.bp.107.048678].
Medical students can tell some grim stories about teaching to undergraduates,
such as being told to always suggest Olanzepine in practical vivas
for anything diagnosed as psychosis from the actors. Through
to consultants stating that “anyone who self harms has a borderline
personality disorder, and is generally a horrible person with no
hope”. Not much of the arts in there...although I would like
to recommend all medical schools screen Terminator 2 and say, see
- that's what happens when you don't believe your patients!
At Mind’s annual conference in 2007 there was a workshop looking
at the topic of ‘Is the training of psychiatrists fit for
purpose?’ There was broad agreement that current training
of psychiatrists had too much emphasis on neuroscience with not
enough attention paid to life experience and personal qualities.
Cultivation of empathy, respect and humility is not always encouraged
within general medicine. Workshop participants felt diagnosis and
drugs were limited in their usefulness and that psychiatrists often
didn’t engage with the context of people’s distress,
nor appreciate social reality and difficulties as key factors in
was agreement that psychiatrists spent too much time in hospital
settings and needed to train and work more in the community, voluntary
sector, and in user and advocacy projects. Also to be exposed to
wider influences ie. faith traditions , shamanic and psychic studies,
parapsychology, arts, philosophy.
I agree with Allan that what trainees actually get are endless scales,
screens, inventories, risk assessments, risk crystal balls [ok I
made that one up], facile proformas, and outcome measures. And of
course Olanzepine and CBT and Olanzepine and CBT.
Oh the banality of 'personality disorder' - I couldn't agree more.
Many nurses detest this diagnosis along with many service users.
Even those of us who don't have the diagnosis detest it because
we've witnessed how that diagnosis has decimated lives. Some nurses
and service users want to set up an anti-PD diagnosis campaign,
to get rid of the diagnosis from the DSM, in a similar vein to the
CASL campaign for Schizophrenia.
I find it hard to see how psychiatry is fun or exciting to work
in much of the time, I think it can be damaging to its workers.
I'm amazed by those critical thinkers who manage to remain in a
profession which is so risk aversive and evidence-based-obsessed.
Backed up by bad politics and a mental health act which would have
psychiatrists detain people just in case they commit an offence
or default on medication. As a friend with drug induced tardive
dystonia said to me: "Fun? depends which side of the hypodermic
Phil Barker, honorary professor of medicine, nursing and dentistry,
University of Dundee, Scotland
June 11, 2009
it just me, or is there not something bizarre, stupid or offensive
about claiming that "psychiatry is the most exciting and fun
speciality of medicine". I suspect that many people who feel
moved to consult a psychiatrist (or their families for that matter)
will find the idea that any such a 'consulation' might be either
'exciting' or 'fun' for the doctor concerned, most alarming. Can't
imagine paediatric oncologists (or any other medical speciality)
framing itself as a 'fun' discipline.
psychiatry 'is', it seems clear it is not a medical speciality.
There are indeed a lot of people who appear to need someone (or
perhaps even lots of people) to help them deal with their various
problems in living. Whether or not they need 'specialist doctors'
is another question altogether.
Professor Bhugra needs to 'go back to basics'. What 'exactly' does
a medical speciality of psychiatry offer people, that they cannot
find elsewhere? That seems far more realistic than trying to turn
psychiatric medicine into something, which the mdia types would
Kim Sherrington, lead clinician/unit manager, day group therapy
unit, Avon and Wiltshire Mental Health Partnership NHS Trust
June 15, 2009
Such a clumsy statement may well be symptomatic of a branch of medicine
that is still just as determined to call itself an exact science
as it always has and therefore maintains the biological dominant
The arrogance of our branch of medicine still bewilders and frustrates
me after thirty years within said branch.
Despite the world populace view that it is life experience that
causes mental health problems and that the debate as to what constitutes
'mind' or even if it exists continues, the medical profession, ably
supported by Giant Pharma, continue the journey down the pathological
road of 'explanation'. Hence the importance of choosing what one
says and its effects carry little concern.
will it take for the psychiatric medical establishment to let go
of its modernist, 'expert' and arrogant stance and demonstrate some
humility by acknowledging the truth about what it doesn't know?
Issue: At work
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