Electronic Letters to:
|
|
eLetters: Electronic letters published:
-
![[Read eLetter]](/icons/misc/sectionDOWN.gif)
New Ways not Working and the consultoid (1,2)
- Claire Hilton (18 June 2009)
-
New Ways Can Work
- David J Ogden (18 June 2009)
-
New ways of losing the art of psychiatry
- Dr Cleo Van Velsen (24 June 2009)
|
|
|||
|
Claire Hilton, Consultant old age psychiatrist Central and North West London NHS Foundation Trust
Send letter to journal:
claire.hilton{at}nhs.net Claire Hilton
|
Once again, as a consultant old age psychiatrist in my job planning meeting, I was berated for not organising my time effectively. This ignored the real sources of the excessive work load, under-funding and increasing pathology in an aging population. I was informed that that I need to function as a consultoid rather than as a consultant. This sounded rather sci-fi, perhaps like an android or robot, and very surreal. Unfamiliar with the word, I suspected a clever neologism used in a very authoritative way. I checked the on-line Oxford English Dictionary; it is not there. I thought that perhaps I might try using it when addressing a patient ‘Good morning Mrs X, I’m Dr Hilton, your consultoid’. But it didn’t sound right. So I searched the internet; consultoid appears to be an imprecise term including people training to be consultants(3), GPs wanting to keep a hand in hospital work (4), and health service developments being made without consultation with clinicians.(5) Indeed, far from sci-fi it is quite an old word, at least as far back as 1929.(4) New ways of working with increasing workloads, doctors being removed from the diagnostic, assessment and treatment roles for which they were trained and being ‘consultants to the team’ is perhaps reconstructing a modern, virtual-mental-asylum; relatively few medical staff, risk of inadequate diagnoses, almost all work delegated to lower paid staff, and where possible offering social care rather than active medical intervention. Perhaps somewhere, sometime consultoid work will actually be imposed on us from above. But for the moment, just beware if you are asked to be one. It probably implies lower status, less funding, an android like telepathic sci-fi diagnostic method and mind-reading relationship with the clinical team, plus a super-human effort to keep up with the work load. 1. Dale J, Milner G. New Ways not working? Psychiatrists' attitudes Psychiatric Bulletin, 2009; 33: 204-207 2. St John-Smith P, McQueen D, Michael A. et al The trouble with NHS psychiatry in England Psychiatric Bulletin, 2009; 33: 219-225 3. Dunea G. Consultants and Consultoids Br Med J, 1984; 288: 923- 4 4. Lancet. The renaissance of general practice. (editorial) Lancet, 1929; ii: 933 5. ‘Dr Rant’ Would you still trust this lot? May 2007 http://www.drrant.net/2007/05/would-you-still-trust-this-lot.html accessed 6.6.09 |
|||
|
|
|||
|
David J Ogden, Consultant Psychogeriatrician
Send letter to journal:
david.ogden{at}glos.nhs.uk David J Ogden
|
Much is being made of the negative effects of New Ways of Working, to the extent that it's future is now seriously threatened despite viable or palatable alternatives not being proposed within an environment of increasing service demand. Having experienced working in several trusts through the process of adopting New Ways of Working (in working and older age adults), my belief is that the current challenge lies in identifying which factors lead to success, and which do not. The next question is whether the successful factors can be systematized; i.e. are not entirely dependent on individual skill, knowledge or enthusiasm. My view is that the following three factors are of key importance: 1. NWW needs to be clinically lead, and not perceived as being misappropriated by management for their own (financial?) agenda. 2. Strong team leadership to encourage and support care co- ordinators' increased responsibilites. 3. Boundaries between functional teams need to be explicit, without the gaps that GPs hate, and with great emphasis on excellent, protocolled communication standards. Universality and continuity of service delivery are thus ensured. NWW remains in an experimental phase and shows promise. We cannot allow naysayers whose fear of obsolescence or displacement from power holds back real progress. New Ways can work. Isn't it time for the college to canvas members to find out how? |
|||
|
|
|||
|
Dr Cleo Van Velsen, Consultant Psychiatrist in Forensic Psychotherapy John Howard Centre, 12 Kenworthy Rd, Hackney E9 5TD. East London NHS Foundation Trust
Send letter to journal:
cleo.vanvelsen{at}eastlondon.nhs.uk Dr Cleo Van Velsen
|
As a consultant working in a tertiary service I see the results of New Ways of working rather than participating directly myself. What emerges is a loss of diagnosis, let alone any attempt at a differential. NWW assumes that it is easy to tell, at the moment of referral, whether or not a problem is complex or strightforward. In reality overt psychosis can be relatively straightforward to spot but these go to the psychiatrists. Left undiagnosed are complex personality disorder (borderline pathology reduced to 'depression') and subtle or unusual psychotic states such as encapsulated delusions or thought disorder, described as 'normal'. I have been involved in an increasing number of cases where there have been serious consequences of misdiagnosis, of the type that used to shame a part 1 candidate for MRCPsych. Diagnosis is still considered a fundamental part of medicine, so why have we, apparantly willingly, opted out of this aspect of our medical discipline. I concur with those who worry about the demise of psychiatry--what is the point of a discipline that seemingly anyone can practice. The loss of differentiation between the disciplines does not contribute to egalitarian practice, it only leads to non specific and perhaps unhelpfully focussed treatment. |
|||