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Custom and standard care: implications for the future role of doctors in mental health

  • Riadh T. Abed (a1)
Summary

Bohmer's concepts of custom and standard care are briefly discussed with specific reference to their implications for the role of doctors in mental health services. It is argued that these concepts help to clarify the unique contribution of doctors within multidisciplinary teams and help define the limits of standardisation in mental health services.

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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.
Corresponding author
Riadh T. Abed (riadh.abed@rdash.nhs.uk)
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Declaration of interest

None.

Footnotes
References
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1 Department of Health. New Ways of Working for Everyone – A Best Practice Implementation Guide. Department of Health, 2007.
2 Department of Health. Responsibility and Accountability: Moving on for New Ways of Working to a Creative, Capable Workforce. Department of Health, 2010.
3 Bohmer, RMJ. Designing Care: Aligning the Nature and Management of Healthcare. Harvard Business Press, 2009.
4 NHS Quality Improvement Scotland. Integrated Care Pathways for Mental Health: Bipolar Disorder, Borderline Personality Disorder, Dementia, Depression, Schizophrenia. NHS Quality Improvement Scotland, 2007 (http://www.nhshealthquality.org/nhsqis/files/MENTALHEALTHICP_STAND_APR07.pdf).
5 Unützer, J, Katon, W, Callahan, CM, Williams, JW JR, Hunkeler, E, Harpole, L, et al. Trial in the primary care setting: a randomized controlled collaborative care management of late-life depression. JAMA 2002; 288: 2836–45.
6 National Institute for Health and Clinical Excellence. Depression (CG90) The Treatment and Management of Depression in Adults. NICE, 2009 (http://egap.evidence.nhs.uk/CG90/).
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BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
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Custom and standard care: implications for the future role of doctors in mental health

  • Riadh T. Abed (a1)
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eLetters

Disservice to the most needy!

millia begum, Consultant Psychiatrist
22 December 2010

I would be extremely concerned that our patients with the major mental illnesses under this model would be classed as 'standard care' and would be handled by non-medical professionals. To me, this is callous care and not standard care. It is a theoretically smart sounding concept but at a clinical levelmost good clinicians would appreciate that just knowing the protocol and guidelines without knowledge of various other possibilities in the vast array of medical complexities is a dangerous practice.

There is a clear difference between how a doctor diagnoses and attributes complaints to a cause compared to other professionals and these concepts are now being created only to undermine the role of a doctor in psychiatry. What is further concerning is that the history and the future of research is never considered in these theoretical concepts. Research for these standard care patients has come mostly from doctors who have closely worked with these patients day in and day out learning the subtleties of their presentations.

If research is to continue doctors will have to work closely with these 'standard care' patients!

This is a seriously concerning model to me.
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Conflict of interest: None Declared

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