Qualities of a good psychiatrist

Introduction: There is limited published work regarding the qualities of a good psychiatrist in Asia. With greater attention paid to psychiatry training in Singapore as a result of the Ministry of Health's National Mental Health Blueprint, there is a need to assess the qualities of a good psychiatrist to guide training. Methods: The present study consisted of two steps. First, a focus group of six senior psychiatrists was conducted to obtain a list of positive qualities of a psychiatrist. Second, an anonymous survey was sent to all psychiatry trainees and psychiatrists in Singapore to assess the relative importance of 40 qualities that were chosen from the list of qualities obtained from the focus group. Factor analysis was performed to elucidate the themes from the qualities and Friedman's χ² test was used to compare the ratings between themes. Results: The response rate was 48.7% (74 of 152). Analysis showed four themes among the qualities assessed: “personal values”, “professional”, “relationship”, “academic‐executive”. The highly ranked themes for a good psychiatrist were personal values and professional qualities. Lowly ranked themes were relationship and academic‐executive. Discussion: A good psychiatrist in Singapore is narrowly defined by personal values and professional qualities. Training should correctly be focused on clinical skills. There may be a place to give more emphasis to qualities within the themes of relationship and academic‐executive, which are related to the all‐round development of a psychiatrist.     

Agreement between physicians and liaison psychiatrists on depression in old age patients of a general hospital: influence of symptom severity,age and personality

Objective: Comorbid depressive episodes are common among general hospital inpatients. However, existing evidence shows that depression is often poorly recognized in patients aged over 60 years. The aim of the study was first to determine the degree of agreement between primary care physicians' and liaison psychiatrists' evaluation of depression, and second, to analyze how patients' clinical presentation and personality traits influence this degree of agreement.

Methods: Agreement was defined as the matching of the physicians' initial referral for depressive mood and the actual diagnosis of a major depressive disorder evaluated by the consultation–liaison service in 148 inpatients aged 60+ years. Nature and severity of psychiatric symptoms were rated on the HoNOS65+ scale and patients' personality traits were assessed with the Big Five Inventory.

Results: Forty percent of the patients referred for depressive mood were indeed diagnosed with major depression. Agreement between physicians and psychiatrists was most likely in patients with more severe depressive symptoms and younger age. In contrast, risk for non-agreement was increased for patients with more open personalities, yet lower levels of neuroticism, who were referred for depressive mood even though they presented another or even no psychiatric disorder.

Conclusion: These data reveal that the detection of late-life depression in general hospitals may be critically influenced by age, symptoms severity and personality traits.     

Autopsy services for old age psychiatrists in england and wales: Can neuropathologists help?

We have previously shown that many old age psychiatrists are dissatisfied with their local autopsy services. Their most common complaint was the poor quality of central nervous system examinations carried out by general histopathologists, and so we sought to determine whether neuropathologists could carry out more autopsies on old age psychiatry patients. A postal questionnaire was used, and responses indicate that neuropathologists carry out an average of 8.8 autopsies on old age psychiatry patients each year, out of a mean total of 42.2 neuropathological autopsies, and examine an average of 28.3 other brains from old age psychiatry patients, out of a mean total of 109.3 cases. In general, respondents found autopsies on psychiatric and neurological patients much more interesting than autopsies on neurosurgical and forensic cases, but did not rate psychiatric autopsies as more important than any other kind of case. Most neuropathologists would wish to examine more brains from old age psychiatry patients, but would require more pathologists, more technicians or more resources before doing so. Old age psychiatrists who wish to obtain a better autopsy service may need to take the initiative.     

The role of the psychiatrist: job satisfaction of medical directors and staff psychiatrists

In a previous survey of Columbia University Public Psychiatry Fellowship alumni, medical directors reported experiencing higher job satisfaction compared to staff psychiatrists. To further this inquiry, the authors conducted an expanded survey among the membership of the American Association of Community Psychiatrists (AACP). We mailed a questionnaire to all AACP members. Respondents categorized their positions as staff psychiatrist, program medical director or agency medical director, and rated their overall job satisfaction. The form also included a number of demographic and job characteristic items. Of 479 questionnaires mailed, a total of 286 individuals returned questionnaires (61%—12 forms were undeliverable). As in our previous survey, medical directors experience significantly higher job satisfaction compared to staff psychiatrists. Program and agency medical directors do not differ significantly. In addition, job satisfaction is strongly and negatively correlated with age for staff psychiatrists but not for medical directors. This survey strengthens the previously reported advantage medical directors have over staff psychiatrists regarding job satisfaction. The finding that job satisfaction decreases with increasing age of staff psychiatrists but not medical directors is particularly interesting, suggesting that staff psychiatrist positions may come to be regarded as dead-end over time. Psychiatrists are advised to seek promotions to program medical director positions early in their careers, since these positions are far more available, and provide equal job satisfaction, compared to agency medical director positions.     

The association between psychiatrist numbers and hospitalization costs for schizophrenia patients: a population-based study

OBJECTIVE: This study explores the association between psychiatrist case volumes and costs for hospitalized schizophrenia patients. METHODS: The study uses the Taiwan National Health Insurance Research Database for 2003, identifying the study subjects from the database by ICD-9-CM principal diagnosis code 295. Our study sample comprises of 135,621 admissions treated by 787 psychiatrists in 181 hospitals, with the sample being divided equally into three psychiatrist volume groups: or=601 admissions (high volume). After adjusting for psychiatrist, patient and hospital characteristics, multiple regression analyses were performed to determine the association between psychiatrist case volume and hospitalization costs (total, drug, and non-drug). RESULTS: The regression analyses showed that after adjusting for psychiatrist, patient and hospital characteristics, average treatment costs associated with hospitalized schizophrenia patients were inversely related to psychiatrist volume. The respective total costs, drug costs and non-drug costs of patients treated by high-volume psychiatrists were 369 US dollars (p<0.001), 26 US dollars (p<0.001) and 343 US dollars (p<0.001) lower than those of low-volume psychiatrists. The respective total costs, drug costs and non-drug costs for those treated by medium-volume psychiatrists were 248 US dollars (p<0.001), 22 US dollars (p<0.001) and 226 US dollars (p<0.001) lower than those of low-volume psychiatrists. CONCLUSIONS: We find that after adjusting for patient, psychiatrist and hospital characteristics, an inverse volume-cost relationship exists for psychiatrists treating schizophrenia patients. Further studies should aim to investigate the volume-quality relationship to ensure that incremental cost savings associated with increased patient volume are not achieved at the expense of quality of patient care.     

Autopsy services for old age psychiatrists in England and Wales: A survey of consumer satisfaction

Anecdotal evidence suggests that some old age psychiatrists are dissatisfied and disillusioned with their local autopsy services, and so we carried out a postal survey to assess the extent of the problem. Our most striking finding was that over a quarter of old age psychiatrists are, indeed, dissatisfied with the way other organ systems were examined. This dissatisfaction is very strongly associated with services where autopsies on psychogeriatric patients are carried out by general histopathologists, especially where there is no established facility for the brain to be preserved and subsequently examined by a neuropathologist. The main complaint about neuropathologists was that reports sometimes took an unacceptable length of time to be returned to the clinician. The solution to the difficulties experienced by old age psychiatrists would be a closer association with their local neuropathology services, but whether neuropathologists are in a position to increase their workloads remains to be determined.     

Experiences of patients hospitalized during the Texas mental health scandal

TOPIC. The impact of psychiatric hospitalization on children and adolescents hospitalized during the Texas mental health scandal.
METHODS. Content analysis of archival data and in-depth interviews.
FINDINGS. subjects> (N = 19) voiced complaints about the stigma resulting from the hospitalization as well as lack of individual care, violations of personal boundaries, ineffectual outcomes, permanent disruption to family relations, separation from family, trauma of seeing others restrained, and being restrained themselves.
CONCLUSIONS. Unnecessary psychiatric hospitalization has long-term ramifications for children and adolescents in terms of self-view, family, and social relationships.     

Qualitative Assessment of Mental Health Service Satisfaction: Strengths and Limitations of a Self-Administered Procedure

A qualitative procedure based on self-administered open-ended questions was assessed in three psychiatric outpatient clinics in Montreal. Acceptability to clients, mode of administration and convergent validity were evaluated. Comparison with findings from personal interviews demonstrates a lower frequency in responses but similar patterns in sources of satisfaction/dissatisfaction. Scores generated by quantification of responses to one of the open-ended questions presented a significant correlation with a standardized questionnaire (OQOS) administered to 242 psychiatric outpatients. Findings suggest that a self-administered procedure based on open-ended questions could be practical and useful for both formative evaluation and monitoring in environments with limited resources.     

The reliability of child psychiatric diagnosis. A comparison among Danish child psychiatrists of traditional diagnoses and a multiaxial diagnostic system

The study was conducted to compare an experimental multiaxial diagnostic system (MAS) with traditional multicategorical diagnoses in child psychiatric work. Sixteen written case histories were circulated to 21 child psychiatrists, who made diagnoses independently of one another, using two different diagnostic systems. Diagnostic reliability was measured as percentage of interrater agreement. The highest diagnostic reliability was obtained in psychotic disorders, the lowest in personality disorders. The MAS implied improved diagnostic reliability of mental retardation, somatic disorders and developmental disorders. Adjustment reaction (reactio maladaptiva) was the diagnosis most commonly used, but with varying reliability in both systems. The reliability of the socio-economic and psychosocial axes were generally high.