Psychiatric Bulletin (2005) 29: 71. doi: 10.1192/pb.29.2.71-a
© 2005 The Royal College of Psychiatrists
Psychiatric Bulletin (2005) 29: 71
© 2005 The Royal College of Psychiatrists
Consultant psychiatrists’ working patterns
John M. Eagles, Consultant Psychiatrist
Royal Cornhill Hospital, Aberdeen AB25 2ZH
Mears et al (Psychiatric Bulletin, July 2004, 28, 251-253) advocate
that consultants should work in ‘progressive roles’ in order to
combat occupational stress. This role includes a low accumulation of patients
from other members of the multidisciplinary team, scope for delegation, time
to respond to emergencies, taking a low level of direct referrals, and feeling
support from and reliance upon other team members. Consultants working in such
a role are more positive and less stressed.
However, there is nothing in the methodology to indicate that the numbers
of supporting team members were considered in the analysis. Surely, all of the
above factors may relate pretty directly to the number and quality of other
members of one’s team, and without sufficient multidisciplinary
colleagues it is rather difficult to envisage consultants surviving in the
suggested ‘progressive’ role. In the absence of such data, and of
any consideration of team sizes, the paper’s recommendations appear
fairly vacuous.
Author’s reply
Alex Mears, Research Fellow
Royal College of Psychiatrists’ Research Unit, 83 Victoria Street,
London SW1H 0HW. E-mail:
alex.mears{at}virgin.net
In his letter Dr John Eagles points out that the assertion in our paper
that consultant psychiatrists working in more progressive roles (low
accumulation of patients, effective delegation, good team working and support,
effective gate keeping and low level of direct referrals, time to deal with
emergencies) are likely to suffer less from occupational burdens is flawed,
since no consideration is given to the number and/or quality of team members.
Dr Eagles continues, stating that conclusions and recommendations do not stand
up in the absence of these data, since any consultant not in a sufficiently
populated, effective team would not survive in a progressive role.
My initial response is to state that we indeed did collect data about the
size of the respondent’s team. These data weren’t included in this
paper as submitted to keep the length down to publishable level. In common
with many national studies, the original dataset for this project is vast and
contains several hundred variables. We are forced to choose not only which to
analyse in depth, but must create a subset of those to submit for publication
in peer-reviewed journals. I can report, however, that team size was included
as a predictor in some of our univariate (the larger the respondent’s
team, the higher their reported satisfaction level [P<0.05]) and
multivariate (the larger the team, the lower the respondent’s General
Health Questionnaire - version 12 score ([P<0.05], and the less they suffer
from depersonalisation [P<0.01]) analyses. My second point concerns Dr
Eagles’ interpretation of the findings more generally. I feel that Dr
Eagles has rather missed the point of this paper: the progressive model can
only ever work where the consultant has a motivated, effective
multidisciplinary team. A progressive role, by reference to its defining
characteristics, cannot be achieved without it. Further, the more important
point here is that a consultant cannot change in isolation: as we point out in
the paper, any change of role is potentially dangerous unless carried out as
part of a whole-systems approach to change, a restructure, where due
consideration is given to ensure that any reduction in workload is not merely
passed onto other team members, rendering them liable to stress and
burnout.
