Excellence in training – what makes a good psychiatrist?

Professor Dinesh Bhugra - Proud to be Grumpy! This was the surprise opening statement that Professor Dinesh Bhugra, President of the World Psychiatric Association, made to a capacity audience assembled during this plenary session to hear his views on how to provide excellence in the training of psychiatrists. 

As he explained, he, like all physicians as they become older, has become increasingly grumpy and some recurrent frustrations still continue to irk him. In particular, he finds it ever harder to understand why, when we recruit the brightest and best students into the field of medicine, we, as part of their training, continue to beat the humanity out of them, turning out technicians and technocrats instead of healers.  In Professor Bhugra’s opinion, psychiatry should be at the heart of medical training from the outset so that instead of creating driven, competitive individuals who are expected to become members of a team, we produce real team players capable of working effectively with others for the overall benefit of the patient from the outset. 

He then explained how, as the practice of psychiatry has moved away from the hospital to the home, different skill sets are needed. These, in turn, are driving the changes in training that prospective psychiatrists should be given.  

A number of challenges need to be addressed to optimise treatment delivery. Public mental health is still not taken seriously enough and, in his opinion, the stigma of mental illness will never go away. Service quality continues to vary widely.  The impact of psychopharmacogenomics is likely to be huge in the future which, in turn, means training in the use of targeted drugs will need to be incorporated into psychiatry training programmes.

One problem that arises now, and will continue to arise, is that psychiatric patients don’t really want medicine – it isn’t their top priority. Accommodation, employment and social relations take precedence over drugs in a patient’s view and psychiatrists shouldn’t relinquish their advocate role for the patient in this regard.

One major ‘grump’ Professor Bhugra has is with the French philosopher Descartes who separated the needs of the body and the mind. For too long have physicians and psychiatrists observed this misguided paradigm and not communicated with each other. “Psychiatrists as a group should be proud – we deal with the most difficult patients in society,” said Professor Bhugra, before provocatively adding, “If a physician isn’t bright enough for psychiatry, they should become surgeons!”

He then went on to discuss some of the characteristics required of a good psychiatrist. As well, as being an expert healer, scholar and manager, importantly and possibly above all, a psychiatrist needs to be a communicator, a collaborator and an advocate for his or her patients. As was pointed out, if psychiatrist don’t advocate for patients, patients won’t support psychiatrists. Indeed, it is Professor Bhugra’s experience that on the several occasions that he has gone to lobby Government or to educate specific groups, misconceptions appear to be more easily overcome and the desired objective achieved when he was accompanied by a patient. Thus, working with and listening to patients is fundamental to the role of the psychiatrist.

During his presentation Professor Bhugra highlighted numerous aspects of psychiatric training that should be considered. For, example, what is the definition of confidentiality when dealing with a patient with mental illness?  All too frequently, patients are seen in the presence of family and other supporters making confidentiality an interesting ethical issue.

The notion of public health was another important area touched on. Approximately 50% of patients with psychiatric disorders first start experiencing symptoms before they are 15 years of age, and 75% before they are 25. Therefore, maternal and childhood mental health management strategies need to be examined and clarification of how early intervention approaches to handle mental illness can be actioned is needed.

In going through the characteristics of a good psychiatrist, members of the audience were making noticeable nods of agreement when Professor Bhugra described the need not only for compassion but also for self-awareness when managing patients. Recognising how one’s own prejudices can subconsciously become incorporated into the way one handles a patient and the role of transference and counter-transference between patient and psychiatrist should be an integral part of a trainee’s education.

Social media and its various impacts on different generations also needs to be recognised and training methods need to be adapted to suit the media-savviness of trainees. Generation X is now Generation Z! Indeed, as Professor Bhugra concluded, it is an exciting time to be a psychiatrist as so many discoveries lay ahead. Psychiatrists need to grab these opportunities – and be proud of their profession!

Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented.
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