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

1. Defining Professional Roles for PsychiatristsProfessor Dinesh BhugraProfessor of Mental Health & Cultural DiversityInstitute of Psychiatry, King’s College LondonPresident, The Royal College of Psychiatrists

2. 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

3. Characteristics Medical expert and healer Professional Manager Communicator Scholar Collaborator (team player) Advocate

4. Disease vs Illness Doctor vs Patient Expectations of the therapeutic encounter Explanatory Models Experience

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

6. 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 Interactive components of the patient-centred process (cont)

7. 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

8. 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 Characteristics of agood psychiatrist

9. 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 Core attributes: Good Psychiatric Practice

10. 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 patient’s problem Core competencies

11. 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 Core competencies (cont)

12. 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 Core competencies (cont)

13. 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 Essential roles and key competencies

14. 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 Essential roles and key competencies (cont)

15. 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

16. 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

17. 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 Essential roles and key competencies (cont)

18. 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 Essential roles and key competencies (cont)

19. 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 Essential role and key competencies (cont)

20. 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 Attributes

21. 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 Attributes (cont)

22. 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 Attributes (cont)

23. Attributes

24. Managerial Skills Effective and efficient working Utilise IT Health Advocacy Health promotion and prevention Advocate for patients (families and communities) Attributes (cont)

25. 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

26. Interpersonal and communication skills competencies Level 2 Partnerships with patients and carers Transmit information clearly and meaningfully Understand ‘ counter-transference’

27. Interpersonal and communication skills competencies Level 3 Communicate collaboratively and work with multidisciplinary team members Educate patients, carers, community

28. 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 Systems based practice

29. Conclusions Who is a good psychiatrist? How is practice defined? Who defines it? What is the role of the psychiatrist?