Monday 9 March 2009


I've been talking with managers at work about psychiatrists. Rather a lot, of late. I work in the NHS, changes are afoot, changes are always afoot. I talk with endless folk, endlessly, because it allows me protect my corner and be left alone to do what we do best. All that seeing patients and making things better malarky.

Managers have a different agenda. They usually are not thinking about the personal and privileged relationship a doctor or nurse, in a room with a patient, have, and how management can make this work best for one and all. Many years ago, that's what I imagined managers did. Now I remain buoyant and optimistic but I'm not so naive.

As an aside, Professor Sir Bruce Keogh, Medical Director at the Department of Health, does seem to have his finger on the pulse. The Jobbing Doctor feels, as many medics do, that our Chief Medical Officer has much to be contrite over. I am heartened that Bruce Keogh was saying how everything managers do, all systems that are in place, should be to improve the quality of that privileged moment of a therapist and their patient, in a room together, getting help. Superb!

Most weeks I speak with managers in our organisation, in neighboring FTs and with the PCT. The LMC and APC like to shred Consultants in Secondary Care too. The role of psychiatry in undergraduate teaching is modest, discussions I have with the university policy makers as an old age psychiatrist are laughable. But I enter the lions' dens time and time again because if I didn't I'd get sold down the river and life for me, our teams and my patients what be a whole heap worse.

I've also undertaken formal investigation of rubbish psychiatry in a neighbouring area. As well as middle grade doctors who've needed performance management, it got worse than that. Always grim, to see practice by a Consultant that's beyond poor and in to utterly shameful.

With patients, commissioners and staff I find myself increasingly having to justify the role of a Consultant Psychiatrist. In my corner, oddly, Old Age services are well regarded by all parties, so the knives are out for colleagues. Therein lies another post.

Suffice to say, we live in interesting times.

Normally, when a crowd get together and pool decision making, decisions are better. Sources of bias and error are cancelled. Guess the weight of a jar of sweets. You'll guess wrong. So will most folk. But use the crowd's answers and pool the answers, take an average, and you'll likely get close. Still not right, maybe, but better than the guess you'd have made yourself.

It was of interest to me, then, to see that this "wisdom of crowds" effect got worse when you gathered 300 psychiatrists together. Read about it here.

My managers will love this . . .


Spirit of 1976 said...

Unfortunately bad consultants do exist - bad nurses too, sadly.

This may be just an anecdotal impression on my part, but I've noticed that the best psychiatrists tend to gravitate towards elderly care, and the worst ones towards CAMHS. Possibly something to do with which end of the spectrum has the most Proper Doctory Stuff to be done, and which has the least.

Like I said, I'm going on anecdotal impressions, but I've certainly worked for some dismal consultants since joining CAMHS.

Oliver Smith said...

don't say that Zarathusta...if I ever make it med school it's CAMHS I want to specialise in!

Very well written as ever shrink!

That's not my name! said...

There are rubbish psychiatrists (nurses, care co-ordinators etc etc)..but if I am being honest and putting heavy scepticism to one side there are decent human beings trying to do the best they can for people in a system that is pants.

Which, I think is more often than not the case.

Hmm...or at least 50/50. I have experienced decent people being bureaucratised and losing sight of (or more the faith which goes with) the reasons why they joined the psychiatric profession in the first place. I see it happening with my support worker right now.

In the space of a year, they have gone from being enthusiastic and consistent (as in turning up to agree visits) to externally accepting they are trapped in the system whilst every other week they are on leave or sick or called away to a meeting.

Senior Managers of the Trust I am served by say (openly) there is a 'cultural' in staff have become complacent and bad habits prevail. I think it is worse than that...I think it is a system's problem, where bureaucracy and red tape perpetuates disillusionment (either leading to professionals choosing another profession or becoming complaint to the point of not caring).

Hoorah for those who continue to try and battle through this on their patient's behalf and even bigger cheers for those that get somewherfe but, from what I see and experience, they are up against it..

but not as much as their patients.

Spirit of 1976 said...

Oliver, if you're a law student and want to work in CAMHS, you'd probably be better off doing a social work diploma than a medicine degree.

Your law background would stand you in good stead, you'd have less extra years of training so you'd get to where you want to be quicker and accumulate less debt along the way, and a newly-qualified social worker earns roughly the same as a newly-qualified doctor.

A lot of the psychiatric SHOs that I work with tend not to enjoy CAMHS because they feel that they've spent all these years training in medicine only to do a mix of psychology and social work. As a result they tend to leg it to elderly psychiatry so they can do more of the actual medical stuff.