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Quality thinking and a formula they can't refuse

  • Nick Child (a1)
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In the peripheries of excellence, providing a service is the main task. Professor Nichol says that describing a child psychiatry service to managers is easy (Third Section Newsletter). I say it is and it is not. The way he does it follows the traditional bioscientific medical pattern and logic - number and range of cases and diagnoses etc. Health managers at a first glance may be quite happy with this ‘biomedical’-looking picture. But I believe that in their second glance they can tell that these expensive child psychiatrists, who just sit in rooms talking, are not dealing with the same thing as surgeons and physicians.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
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(1) This paper was originally presented in the ‘How I Do It (in eight minutes!)’ section of the 1990 Annual Residential Conference of the Child and Adolescent Specialist Section of the Royal College of Psychiatrists, held in Glasgow.
(2) I would deny that this paper shows me to be antiestablishmentarian. I am forever grateful to those colleagues who drain themselves into the ‘centres’ - professional bodies, universities, large and/or teaching hospitals, in-patient units, mainline training and teaching, other courses, writing text-books, doing research etc. Without the ‘centres’, there could be no ‘peripheries’ of excellence.
(3) ‘Futile’ from the point of view of service provision where a simple diagnostic category or label only rarely has the same useful power as diagnoses in biomedical fields. One good result of the present government's policy is to remind us that quality service provision is actually the primary aim supposed to be served by all those other ‘central’ enterprises that often take priority over service considerations.
(4) I draw from D. C. Taylor's ideas. For references see my letter, ‘The Myth of Hysteria as Illness’ (Journal, December 1989, 155, 865866). Unlike ‘diseases’, ‘predicaments’ are unique, which is why further classification is less useful clinically. But we can still seek better frameworks for classification -‘problem-solving styles’ perhaps?
(5) This medical authority does not often have to contribute explicitly within a multidisciplinary team. When anything explicit is needed, it is usually only good history taking and discussion. If any further biomedical attention is indicated - usually referrals will have already had quite enough - the case can be referred back to ‘proper’ medics.
(6) An added bonus of this way of thinking is that you get on far better with colleagues in the biomedical branches of medicine because you confirm what they have always known - that you are working with people and problems that are not in the same realm as biomedical disease. It is more likely that non-medical professionals and agencies occasionally dislike this way of thinking for, like the families themselves, they may wish for an unduly mystical power to hand over to.
(7) Our ‘quality thinking’ here is diametrically opposed to the present government's. The idea of inter-agency collaboration (although widely considered essential) is incompatible with creating a competitive market-place. May the best thinking win!
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Quality thinking and a formula they can't refuse

  • Nick Child (a1)
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