"Other than the aforementioned [the specific ability to include/exclude organic disorder], do our learned colleagues (cue the doc) uphold any other aspects of the medical training that supports their (purely) mental health skills?"
- Mr Ian's comment at Mental Nurse.
This piqued my interest.
In addition to dealing with organic disease, which I guess we'd all agree only doctors are trained to do, there are a few things that support mental health skills.
Diagnosis. We're the only group of professionals trained in broad diagnosis. I recognise that psychologists can diagnose mental retardation. Some can make formulations around personality disorders with credibility, too. But beyond this, the clustering of symptoms, the weighting and interplay of intensity, pervasive nature, impact on function, chronicity and associated features is something that medics are trained to sleuth out. Trained specifically in mental health, sure, but that training can happen readily since our background of 7 years training before this (minimum of 5 years medical school then foundation training) before mental health training means doing diagnosis is what we live and breathe. I still maintain that only psychiatrists have the competence to ascribe significance to psychopathology and generate diagnosis from this. Some are rubbish at it, I've met woeful psychiatrists who are ghastly at this. But for those who are up to speed, good medicine with competent psychiatrists allows good diagnosis that nobody else is trained to do.
Therapeutics. I work with a pharmacist in my team. She knows a lot about drugs. She knows a fair bit about physiology and mental health, a bit about anatomy and a bit about clinical work. If I want to know about drug interactions or if Symptom X could be from Drug Y she's the woman who knows. She's great at medicines reconciliation and all the governance gubbins we need to do. She frankly states, despite her extensive training and vast pharamcological knowledge, she's not the one to guide on treatment. Clinical outcomes, what's tolerated well and what's not, peripheral consequences to taking medication all is learned from follow up (which CPNs or I do) so she doesn't have her finger on the pulse to make as informed decisions on therapeutics as I do. In most cases, medics have a better, more contextual and richer awareness of therapeutics than other professions.
Legal awareness. We're all trained in the Medicines Act, Mental Health Act and Mental Capacity Act. Last week I was quoting the 1861 Offences Against the Person Act to a care home manager. Then I was quoting section 4 (7) (b) of the Mental Capacity Act 2005 on Best Interests because she was acting unlawfully. I liaise with the DVLA on a weekly basis re fitness to drive. I'm section 12 approved to do Mental Health Act admissions which no other profession can do (even come October, only medics can make recommendations for admission). We all do what is right, medics historically have had responsibility stop with them, thus an awareness and obligation to have intimate familiarity with statutory instruments is ingrained.
Expertise. We're trained extensively, over ludicrous numbers of hours, over stupidly stupidly obsessive and obscure levels of detail. A local Nonmedical Prescribing course leader (who is a nurse) said to a district nurse on the course never to consider meningitis when treating kids with infection, since if she did she'd end up referring everything to a doctor and never treat anyone. Medics do the opposite, we are trained to think of everything. When one of my patients returned from a holiday in Asia feeling very tired and more depressed and losing weight I considered psychosocial factors but also looked for hypothyroidism and common causes for "tired all the time." One exclusion was diphyllobothrium latum the fish tape worm, since she'd been eating raw fish. Rare as hens teeth, but it's that kind of obscure taking what's said and sifting for patterns that medics are trained in, having greater levels of expertise than non-medical colleagues.
I don't think doctors are better than nurses or psychologists. The question posed was what aspects of training gave us noteworthy skills, which is what I've waffled on about. This gives a different approach from medics which isn't necessarily better, it's just different. Nurses are far far better at many areas of patient care in mental health than I am. Equally, I'd argue medics have strengths that others don't have. So, as usual, I'm banging on saying medics should do medical stuff, nurses should do nursing stuff, and we can all be happy together.