Defining Professional Roles for Psychiatrists Professor Dinesh Bhugra Professor of Mental Health

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Defining Professional Roles for
PsychiatristsProfessor Dinesh BhugraProfessor
of Mental Health Cultural DiversityInstitute
of Psychiatry, Kings College LondonPresident,
The Royal College of Psychiatrists
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Psychiatry

• The branch of medicine that deals with mental
  illness, emotional disturbance and abnormal
  behaviour
• Thus a psychiatrist is a specialist who deals
  with the medical treatment of mental illness and
  the interaction of physical and mental illness

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Characteristics

• Medical expert and healer
• Professional
• Manager
• Communicator
• Scholar
• Collaborator (team player)
• Advocate

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Disease vs Illness

• Doctor vs Patient
• Expectations of the therapeutic encounter
• Explanatory Models
• Experience

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Interactive components of the patient-centred
process (after Brown et al, 2003)

• 1. Exploring both the disease and the illness
  process
• history, physical examination, investigations
• dimensions of illness (Explanatory Models,
  feelings, ideas, effects on function and
  expectations)
• 2. Understanding the whole person
• the person (life history, development and
  personal issues)
• the proximal context (family, employment, social
  support)
• the distal context (culture, community, society)

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Interactive components of the patient-centred
process (cont)

• 3. Finding common ground
• problems and priorities
• goals of treatment and management
• roles of patient and doctor
• 4. Incorporating health promotion and prevention
• health advancement
• avoiding and reducing risk
• early identification
• reducing complications

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Interactive components of the patient-centred
process (cont)

• 5. Enhancing the doctor-patient relationship
• Compassion
• Power
• Healing
• Self Awareness
• Transference and counter transference
• 6. Being realistic
• Time and timing
• Team building and teamwork
• Managing resources

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Characteristics of agood psychiatrist

• Good Psychiatric Practice (RCPsych) lists
  attributes of a good
• psychiatrist in the following areas
• Trusting relationship
• Good clinical care
• Consent to treatment
• Note keeping and inter-agency/inter-professional
  communication
• Confidentiality
• Availability and emergency care
• Working as a member of the team
• Referring patients
• Clinical governance
• Teaching and training
• Researcher
• Being a good employee and employer

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Core attributes Good Psychiatric Practice

• Clinical competence
• Being a good communicator and listener
• Being sensitive to gender, ethnicity and culture
• Commitment to equality and working with diversity
• Having a basic understanding of group dynamics
• Being able to facilitate an atmosphere within a
  team
• Ability to be decisive
• Ability to appraise staff
• Basic understanding of operational management
• Understanding and acknowledging the role and
  status of vulnerable patients
• Bringing empathy, encouragement and hope to
  patients and carers
• Critical self awareness of emotional responses to
  clinical situations
• Being aware of potentially destructive influence
  in power relationship
• Acknowledging situations where there is potential
  for bullying

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Core competencies

• Demonstrate diagnostic and therapeutic skills to
  manage efficiently and ethically a spectrum of
  patient care problems within the boundaries of
  the speciality
• Elicit a relevant, concise and accurate history
• Conduct an effective physical examination
• Carry out relevant procedures to collect, analyse
  and interpret data
• Reach a diagnosis
• Perform appropriate therapeutic procedures to
  help resolve the patients problem

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Core competencies (cont)

• Access and apply relevant information and
  therapeutic options to
• clinical practice
• Pose an appropriate patient related question
• Execute a systematic search for evidence
• Critically evaluate medical literature and other
  evidence
• Demonstrate medical expertise in situations other
  than indirect patient care. This includes the
  ability to do the following
• Be an expert witness
• Give presentations/public education

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Core competencies (cont)

• Recognise personal limits of expertise
• Decide when and whom to refer to
• Implement own professional development
• Demonstrate effective consultation skills
• - present well-documented patient assessments
  and recommendations both
• in verbal and written forms

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Essential roles and key competencies

• Medical Expert
• Demonstrate diagnostic and therapeutic skills for
  ethical and effective patient care precise
  clinical history, physical exam, investigation
• Assess and apply relevant information and
  therapeutic options to clinical practice
• Demonstrate medical expertise to situations other
  than in direct patient care
• Recognise personal limits of experience
• Demonstrate effective consultation skills with
  respect to patient care, education and legal
  opinions present well-documented patient
  assessment

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Essential roles and key competencies (cont)

• Communicator
• Establish therapeutic relationships with patients
  and their
• families rapport, trust, empathic and
  confidential
• Elicit and synthesise relevant information from
  patients,
• their families and communities (beliefs, age,
  gender, culture)
• Listen effectively, foster understanding
• Discuss appropriate information with patients,
  their families
• and communities and other healthcare
  professionals inform and counsel patients,
  better understanding

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Essential roles and key competencies (cont)

• Team Player
• Consult and liaise with other health
  professionals
• Recognise limits of personal competence
• Contribute effectively to multidisciplinary team,
  activities (training etc)
• Be aware of roles and expertise of other
  disciplines
• Integrate opinions of patients in decision-making

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Essential roles and key competencies (cont)

• Manager
• Managing resources and time effectively to
  balance patient care, learning needs, outside
  activities and personal life
• Allocate finite healthcare and education
  resources effectively and work efficiently
• Utilise IT effectively to surmise patient care,
  CPD

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Essential roles and key competencies (cont)

• Health Advocate
• Help promote health and prevent disability
• Identify social/cultural factors of health
• Recognise and respond to settings related to
  advocacy populations at risk, policy awareness,
  development of policy

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Essential roles and key competencies (cont)

• Scholar/Educator
• Personal CPD strategy and learning needs and
  methods
• Be a critical appraiser of sources of medical
  information
• Educator help others to define learning needs
  and development, provide feedback, adult learning

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Essential role and key competencies (cont)

• Professional
• Deliver highest quality care with integrity,
  honesty and compassion racial, cultural and
  societal issues
• Appropriate personal and interpersonal
  behaviours self-awareness
• Ethically acceptable/responsible local laws

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Attributes

• Medical Knowledge
• Up-to-date knowledge needed to evaluate and
• manage patients
• Clinical Skills
• Demonstrate proficiency in history taking
• Effective physical examination
• (Investigations organise and evaluate)
• Lead and manage diagnostic studies
• Demonstrate practice skills
• Show proficiency in technical skills

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Attributes (cont)

• Clinical Judgement
• Demonstrate clinical reasoning
• Make sound diagnostic and therapeutic decisions
• Understand the limits of knowledge
• Incorporate cost awareness and risk benefit
  analysis
• Interpersonal Skills
• Communicate and work effectively with patients,
  families, other members of the team and agencies

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Attributes (cont)

• Professional Attitudes and Behaviour
• Accountability
• Accept responsibility
• Maintain comprehensive, timely and legible
  medical records
• Available for consultation
• Seek improvement in quality of care provided
• Facilitating learning of patients, communities,
  students and other disciplines

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Attributes

• Professional Attitudes and Behaviour (continued)
• Lifelong learning
• Evaluate critically new medical and
• scientific information relevant
• Self-awareness
• Humanistic qualities
• Demonstrate integrity and honesty
• Demonstrate compassion and empathy
• Respect for privacy and dignity
• Ethical

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Attributes (cont)

• Managerial Skills
• Effective and efficient working
• Utilise IT
• Health Advocacy
• Health promotion and prevention
• Advocate for patients (families and communities)

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Interpersonal and communication skills
competencies

• Level 1
• Listen to and understand patient and NVC
• Communicate effectively with patients -verbal,
  NVC and written
• Develop and maintain therapeutic alliance through
  trust, empathy, honesty, openness and comfort

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Interpersonal and communication skills
competencies

• Level 2
• Partnerships with patients and carers
• Transmit information clearly and meaningfully
• Understand counter-transference

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Interpersonal and communication skills
competencies

• Level 3
• Communicate collaboratively and work with
  multidisciplinary team members
• Educate patients, carers, community

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Systems based practice

• Be aware of and follow protocols and guidelines
• Lead and delegate authority
• Accurate medical data, etc
• Limitation of health care resources
• Awareness of available resources
• Awareness of legal aspects

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Conclusions

• Who is a good psychiatrist?
• How is practice defined?
• Who defines it?
• What is the role of the psychiatrist?