Where’s that stethoscope? A survey of psychiatrists’ attitudes to their role in managing physical health

Publication Date12 Feb 2020
AuthorHarriet Greenstone,Amy Burlingham
SubjectHealth & social care,Mental health,Mental health education
Wheres that stethoscope? A survey of
psychiatristsattitudes to their role in
managing physical health
Harriet Greenstone and Amy Burlingham
Purpose This study aimsto explore current attitudes among doctorsworking in psychiatry, with regard
to their perceivedrole and their confidence in managing their patients’physical health problems.
Design/methodology/approach A 20-item electronic questionnaire was distributed to doctors
working in psychiatry within two large UK mental health trusts in 2018. Quantitative analysis was
conducted,alongside qualitative analysisof free-text comments made by participants.
Findings Many participants perceived their physical examination skills to have deteriorated since
working in psychiatry (78 per cent). Participants were questioned on which professional group should
hold responsibilityfor managing the physical health of patientsunder psychiatric services. A minorityfelt
it should be psychiatrist-led (5 per cent), followedby general practitioner (GP)-led(42 per cent) and then
shared responsibility (47 per cent). The majority felt there should be more focusedtraining on physical
health in the Core (72 per cent) and Advanced (63 per cent) psychiatry training. Key themes from a
framework analysisof qualitative data included potential barriers to sharedcare, psychiatrists’ concerns
regarding their experience and confidence in managing physical health, reasons in favour of shared
responsibility,ideas for training and suggestionsfor improving the current situation.
Originality/value Psychiatric patients may engage less well with health services, yet psychiatric
medication often impacts significantly on physical health. In this context,there is often a blurring of role
boundaries between a psychiatrist and a GP, and there is considerable variation between individual
teams. There is a consistent call formore physical health training opportunities for psychiatristsand for
mentalhealth services to more proactively promote the physicalhealth of their patients.
Keywords Psychiatry, Cardiometabolic risk, Interface between psychiatry and primary care,
Physical health, Postgraduate psychiatry training
Paper type Research paper
The poor physical health outcomes for patients with a serious mentalillness (SMI) are widely
recognised. Among those with SMI, current life expectancy is comparable with that in the
1950s, with more than 40,000 “reducible” deaths had patients received the same
interventions as the general population (NHS England, 2014). Two-thirds of deaths are from
avoidable physical illnesses, such as heart disease caused by smoking. Thornicroft (2011)
highlights how lifestyle factors impact physical health in this group, with high rates of
smoking, poor diet and low physical activity contributing to hypertension, diabetes and
hyperlipidaemia. Yet less than a third of people with schizophrenia in inpatient settings
received the recommended assessment of cardiovascular risk in the previous 12 months
(The Mental Health Taskforce,2016).
There has been a push for “parity of esteem” between physical and mental health including
government initiatives such as the Five Year Forward View for Mental Health 2016 (The
Harriet Greenstone is
based at Medical
Education Department,
Avon and Wiltshire Mental
Health Partnership NHS
Trust, Bristol, UK.
Amy Burlingham is based
at Solihull Early Intervention
Service, Birmingham and
Solihull Mental Health NHS
Foundation Trust,
Birmingham, UK.
Received 17 October 2019
Revised 3 January 2020
Accepted 3 January 2020
Declaration of interest: Authors
have no competing interests.
DOI 10.1108/JMHTEP-10-2019-0056 VOL. 15 NO. 3 2020, pp. 141-155, ©Emerald Publishing Limited, ISSN 1755-6228 jTHE JOURNAL OF MENTALHEALTH TRAINING, EDUCATION AND PRACTICE jPAGE 141

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