Electronic Letters to:

Original papers:
Reuven Manfred Magnes
Out-patient appointments: a necessary evil? A literature review and survey of patient attendance records
Psychiatr Bull 2008; 32: 458-460 [Abstract] [Full text] [PDF]
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Electronic letters published:

[Read eLetter] Outpatients: a necessary evil?
MacDara H McCauley, Curtis Obadan   (10 February 2009)

Outpatients: a necessary evil? 10 February 2009
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MacDara H McCauley,
Consultant Psychiatrist
MRCPsych,
Curtis Obadan

Send letter to journal:
Re: Outpatients: a necessary evil?

macdara.mccauley{at}hse.ie MacDara H McCauley, et al.

Recently, Magnes (Vol 32, no 12, 458-60.2008) wrote a survey of patient attendance posing the question, "Is outpatients a necessary evil?". Frequently, when discussing the role of outpatients the focus of the articles is concerned with attendance( Mitchell & Selmes 2007, Kelly 2008)

We would suggest that research addressing other aspects of the role of outpatients would greatly benefit psychiatry. It should be noted that some have (Killaspy 2007) queried the need for outpatients. This need was robustly defended.(Holloway, 2008).

We believe that the following issues could be considered; What is the purpose of outpatients? Possible responses; 1. Review mental state, adherence, risk etc. 2. Opportunity for the patients questions. 3. Update the GP-other services involved. 4. Consider referral to other members of MDT/services. How often should we see patients and for how long? Furthermore, guidance re appropriate discharge procedures would be very helpful.

Finally, we would like to echo Holloway's suggestion that "a more nuanced discussion" re that 'necessary evil'is urgently required.

MITCHELL,A.J. & SELMES T.(2007)Why don't patients attend their appointments? Maintaining engagement with psychiatric services. Advances in Psychiatric Treatment,13, 423-434.

KELLY, B.D.(2008)Internal audit of attendances at a psychiatry outpatient clinic.Irish Journal of Psychological Medicine,25,136-140.

KILLASPY,H.(2007) Why do psychiatrists have difficulty disengaging with the out-patient clinic? Invited commentary on: Why don't patients attend their appointments? Advances in Psychiatric Treatment,13, 435-437.

HOLLOWAY,F(2008) Engaging with the outpatient clinic:don't throw the baby out with the bath water. Advances in Psychiatric Treatment,14,159- 160.

Curtis Obadan Senior House Officer in Psychiatry, Mater/UCD Rotational training scheme. MacDara McCauley Consultant Psychiatrist, St. Brigid's Hospital Ardee, Co Louth, Ireland.