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Doctors' experience of a bespoke physician consultation service: cross-sectional investigation

  • Maja Meerten (a1), Julia Bland (a2), Samantha R. Gross (a2) and Antony I. Garelick (a1)
Abstract
Aims and method

Our aim was to follow-up on a cohort of self-referred doctors who attended MedNet. We used a two-point cross-sectional design. Measures included three standardised self-report questionnaires administered before and after consultation. Doctors were also asked to complete a service user questionnaire, and data regarding engagement and onward referrals were gathered through case-note review.

Results

A statistically significant improvement in scores on all three questionnaires was found after intervention; however, scores on one subscale, the risk domain of the Clinical Outcomes in Routine Evaluation – Outcome Measure, did not change significantly. Of the doctors at no risk of suicide at intake, nearly two-thirds (n = 41/70, 59%) were sufficiently helped by the consultations provided to not need further treatment. Of the doctors at some risk of suicide at intake, two-thirds (n = 34/51, 67%) did need an onward referral. Only one doctor required hospital admission, an outcome that suggests the approach used is containing and clinically responsive.

Clinical implications

This paper highlights the efficacy, need and importance of specialist services for doctors in difficulty. We found that the bespoke consultation model provided at MedNet is valued highly by the doctors as service users.

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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
Antony I. Garelick (AGarelick@tavi-port.nhs.uk)
Footnotes
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Declaration of interest

A.I.G. is the Associate Dean, MedNet, London Deanery.

Footnotes
References
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1 Firth-Cozens, J. Doctors, their wellbeing, and their stress. BMJ 2003; 326: 670–1.
2 Firth-Cozens, J. A perspective on stress and depression. In Understanding Doctors' Performance (eds Cox, J, King, J, Hutchinson, A, McAvoy, P). Radcliffe Publishing, 2006.
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5 Tyssen, R. Health problems and the use of health services among physicians: a review article with particular emphasis on Norwegian studies. Industrial Health 2007; 45: 599610.
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7 Department of Health. Mental Health and Ill Health in Doctors. Department of Health, 2008 (http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_083066).
8 Garelick, AI, Gross, SR, Richardson, I, von der Tann, M, Bland, J, Hale, R. Which doctors and with what problems contact a specialist service for doctors? A cross sectional investigation. BMC Med 2007; 5: 26.
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Doctors' experience of a bespoke physician consultation service: cross-sectional investigation

  • Maja Meerten (a1), Julia Bland (a2), Samantha R. Gross (a2) and Antony I. Garelick (a1)
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eLetters

Surprising discrepancy between high prevalence of suicidality and low BSI scores

Paul Whelan, Consultant Psychiatrist and Lead Clinician
10 June 2011

Dear Madam

I would like to congratulate Meerten et al. on their excellent paper about the MedNet Service, a service for doctors experiencing psychological problems, in the current issue of The Psychiatrist; and, furthermore, for setting up and running the service in the first instance.

The auhors cite that doctors are a vulnerable group with high rates of psychological disorders [1]. This is in keeping with previous work myself and colleagues conducted on junior doctors using the General Health Questionnaire-12, albeit at a time when they were undergoing a period of extreme stress (the MTAS fiasco) [2,3]. In the second paper we found that 79% of the sample scored above the cut-point for psychological distress and 21% for severe distress (i.e. caseness for treatment).

What perplexed me about the paper, however, was the high rates of suicidality in the MedNet sample (nearly half) but the relatively low scores on the Brief Psychiatric Interview. I am not sure that this discrepancy is

explained sufficiently in the discussion or, indeed, why thesuicidality persisted post treatment despite the other range of outcome measures used indicating improvement.

I would like to hear more from the authors about their views about this phenomenon.

Otherwise, again, I congratulate the authors for this interesting paper .

References:1. Firth-Cozens J. Doctors, their wellbeing, and their stress. BMJ 2003; 326: 670-1.2. Whelan P, Jarrett P, Meerten M, Forster K, Bhugra D. (2007). MTAS fiasco: lessons for psychiatry. Psych Bull, 31:425-7.3. Whelan P, Meerten M, Rao R, Jarrett P, Muthukumaraswamy A, Bughra D. (2008). Stress, lies and red tape. The views, success rates and stress levels of the MTAS cohort. JRSM, 101:313-18.

Declaration of interest: PW and the first author know each other well.
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Conflict of interest: None Declared

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