Tuesday 18 March 2014

Disarmingly Humble

The Royal College of Psychiatrists has published a new Code of Ethics founded on 12 key principles which are worth rehearsing in full here...

The Code states that psychiatrists shall:-

(1) respect the essential humanity and dignity of every patient

(2) not exploit patients’ vulnerability

(3) provide the best attainable psychiatric care for their patients

(4) maintain the confidentiality of patients and their families

(5) seek valid consent from their patients before undertaking any procedure or treatment

(6) ensure patients and their carers can make the best available choice about treatment

(7) not misuse their professional knowledge and skills, whether for personal gain or to cause harm to others

(8) comply with ethical principles embodied in national and international guidelines governing research

(9) continue to develop, maintain and share their professional knowledge and skills with medical colleagues, trainees and students, as well as with other relevant health professionals and patients and their families

(10) have a duty to attend to the mental health and well-being of their colleagues, including trainees and students

(11) maintain the integrity of the medical profession

(12) work to improve mental health services and promote community awareness of mental illness and its treatment and prevention, and reduce the effects of stigma and discrimination

I invite patients and families to consider the psychiatrists with whom they have worked and test their actions against the Code. Many, I suspect, would agree that their psychiatrist does generally live up to the Code although I know anecdotally that there are some who feel badly let down.

Of course psychiatrists can live up to the Code but still fail to assist effectively, mainly for three reasons:

(i) Lack of resources - the Code obviously cannot guarantee that even the most essential services are available: that's beyond the control of individual psychiatrists and even the profession as a whole though obviously they have a significant degree of influence on those who determine resources (and they do their best to exert that influence, in fairness).

(ii) Lack of diagnostic certainty - quite simply our limited knowledge of mental illness makes even basic diagnosis, however carefully undertaken, hit and miss.

(iii) Lack of effective treatments - neither medical nor psychological treatments for serious mental illness are decisively effective and are often hardly effective at all. Antipsychotic medications can be effective at reducing some symptoms some of the time but with a heavy price in unwanted side-effects and limited understanding about how they even work; antidepressants remain crude and undiscriminating; the evidence base for talking therapies is poor, mainly confined to some limited, short-term effects on overt symptoms (like me you may believe that more in-depth therapies could be decisive - but the research just hasn't been done).

Nothing wrong with the Code of Ethics and I generally support the psychiatrists but, like others in the medical profession except perhaps more so, they need to be honest about the limitations of what they can do to help.

I know some individual psychiatrists who are disarmingly humble about the limited resources and the scant progress made in understanding and treating mental illness - and frankly they are the ones I would trust above all and I think they have the best relationships with their patients and with patients' families.

There is no point having high expectations about psychiatry today, every point in investing in research for the future.