The
of
Training
General Practitioners in By R. F. TREDGOLD, M.D., 1 he
new
Act, with
its
emphasis
on
Psychiatry
D.P.M.
treatment at
home,
will
General Practitioners. They responsibility inevitably may have to sign recommendations to get patients compulsorily into hospital; they will probably be asked to give advice on the Act and its implications to many of their patients; and as the Act is designed to reduce prejudices and stigma, their answers on these questions will be extremely important. Besides this, it is probable that General Practitioners will see more cases of minor psychiatric disorders in their general practice, as the prejudice against them (and against, certain types of treatment for them) disappears. We must ask, therefore : what training has the General Practitioner had on this subject? There is no short answer here, for the variation is enormous. In medical schools before the war, training on the subject was little thought of : many of to-days doctors were trained before the war. The ignorance that resulted left many feeling puzzled and inadequate, and so, irritated by "neurotics". The vicious circles set up by such situations are still cast more
spinning briskly.
on
It is true that since the war teaching has increased enormously! it has, moreover, been orientated to deal with the cases to be seen in general practice rather than those in mental hospitals. Most students these days get some systematic training, some acquaintance directly with psychiatric patients (though not always on 138
their
own)
course,
no
and room
some
for
supervision in handling them. There complacency here and much remains
is, of to be
done. Some feel that the average student will fail to learn much until there are compulsory questions in psychiatry in the final examination of every University. This is no compliment to the keener student, but it would raise the standard of the lower level of knowledge, and so probably raise the standard of many General Practitioners. Even those schools with the fullest programme would scarcely regard it as adequate; and the time spent on psychiatry is still only a small fraction of that spent on medicine and surgery. Even conservative estimates put the proportion of psychiatric cases seen in general practice at a third of the total : others suggest it is far higher. Many of these are patients whom the doctor could treat effectively?if only he had more knowledge and more skill.
Clearly, the University teachers have the prime responsibility here; and no doubt they are moving forward. It is possible they could themselves be helped to provide even more, if some sort of "feed-back" from their pupils existed. How often, for example, do they hear comments or criticisms from an old student? Remarks on and omissions would be very welcome to any teacher who is interested in assessing his results?and who isn't? Old pupils are surely not too shy, but, of course, they may be too busy, to take the trouble to do this. In other countries, indeed, with a less conservative tradition in Universities, such criticism does come back more errors
commonly?and more healthily. What of post-graduate training? There are several examples of instruction open to General Practitioners, and to others faced with similar problems, such as industrial medical officers. There
are, for instance, occasional set lectures and demonstrations at many schools; there are week-end courses organised by the National Association for Mental Health; and there are also group discussions run in the presence of psychiatrists, most notable of which has been Dr. Balint's (so well described in his book "The Doctor, his Patient and Illness"). Such groups appear to be on the increase, which indicates an encouraging demand from General Practitioners, but they can hardly yet cover more than the fringe of their requirements. In any case, doctors do not always find it so easy to learn completely new attitudes and techniques once they have become qualified. Such education must, therefore, be supplementary to under-graduate education, not a replacement of it. If so, the teaching schools clearly have some responsibilities here too, even if their prime concern is with undergraduates. The postgraduate schools and institutes must also play their part increasingly, and will no doubt respond more as more demands are made on them by General Practitioners. The trouble often seems to be that each side is waiting for the other to make the first move. Could General practitioners make their views better-known? 139
of
Training
General Practitioners in By R. F. TREDGOLD, M.D., 1 he
new
Act, with
its
emphasis
on
Psychiatry
D.P.M.
treatment at
home,
will
General Practitioners. They responsibility inevitably may have to sign recommendations to get patients compulsorily into hospital; they will probably be asked to give advice on the Act and its implications to many of their patients; and as the Act is designed to reduce prejudices and stigma, their answers on these questions will be extremely important. Besides this, it is probable that General Practitioners will see more cases of minor psychiatric disorders in their general practice, as the prejudice against them (and against, certain types of treatment for them) disappears. We must ask, therefore : what training has the General Practitioner had on this subject? There is no short answer here, for the variation is enormous. In medical schools before the war, training on the subject was little thought of : many of to-days doctors were trained before the war. The ignorance that resulted left many feeling puzzled and inadequate, and so, irritated by "neurotics". The vicious circles set up by such situations are still cast more
spinning briskly.
on
It is true that since the war teaching has increased enormously! it has, moreover, been orientated to deal with the cases to be seen in general practice rather than those in mental hospitals. Most students these days get some systematic training, some acquaintance directly with psychiatric patients (though not always on 138
their
own)
course,
no
and room
some
for
supervision in handling them. There complacency here and much remains
is, of to be
done. Some feel that the average student will fail to learn much until there are compulsory questions in psychiatry in the final examination of every University. This is no compliment to the keener student, but it would raise the standard of the lower level of knowledge, and so probably raise the standard of many General Practitioners. Even those schools with the fullest programme would scarcely regard it as adequate; and the time spent on psychiatry is still only a small fraction of that spent on medicine and surgery. Even conservative estimates put the proportion of psychiatric cases seen in general practice at a third of the total : others suggest it is far higher. Many of these are patients whom the doctor could treat effectively?if only he had more knowledge and more skill.
Clearly, the University teachers have the prime responsibility here; and no doubt they are moving forward. It is possible they could themselves be helped to provide even more, if some sort of "feed-back" from their pupils existed. How often, for example, do they hear comments or criticisms from an old student? Remarks on and omissions would be very welcome to any teacher who is interested in assessing his results?and who isn't? Old pupils are surely not too shy, but, of course, they may be too busy, to take the trouble to do this. In other countries, indeed, with a less conservative tradition in Universities, such criticism does come back more errors
commonly?and more healthily. What of post-graduate training? There are several examples of instruction open to General Practitioners, and to others faced with similar problems, such as industrial medical officers. There
are, for instance, occasional set lectures and demonstrations at many schools; there are week-end courses organised by the National Association for Mental Health; and there are also group discussions run in the presence of psychiatrists, most notable of which has been Dr. Balint's (so well described in his book "The Doctor, his Patient and Illness"). Such groups appear to be on the increase, which indicates an encouraging demand from General Practitioners, but they can hardly yet cover more than the fringe of their requirements. In any case, doctors do not always find it so easy to learn completely new attitudes and techniques once they have become qualified. Such education must, therefore, be supplementary to under-graduate education, not a replacement of it. If so, the teaching schools clearly have some responsibilities here too, even if their prime concern is with undergraduates. The postgraduate schools and institutes must also play their part increasingly, and will no doubt respond more as more demands are made on them by General Practitioners. The trouble often seems to be that each side is waiting for the other to make the first move. Could General practitioners make their views better-known? 139
