Psychiatry in the private sector

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14, 370) on psychiatry in the private sector cannot be allowed to pass unchallenged as it raises important issues in the context of the current political climate. The letter purports to be a brief research report demonstrating that "the Priory Hospital ... is pre pared and able to meet the needs of a representative sample of psychiatric patients". It does no such thing, but is in fact a brief demonstration of the disingenuous art of false inference.
The study attempts to evaluate the clinical activity of the Priory Hospital (private) and the Charing Cross Hospital (NHS) by comparing crude ICD-9 diagnoses of patients admitted as psychiatric emer gencies. It ignores the fact that the objectives of these two institutions are completely different and that they serve demographically dissimilar populations. It compounds this error by implying that the activity of a professorial department in a large London teach ing hospital is similar to the activity of NHS psychi atric units generally. It gives no information as to how patients were "surveyed" or sampled, whether retrospectively or prospectively, how emergency was defined or how, when and by whom diagnosis was made. There are no data on secondary diagnoses, chronicity or severity of illness or on demographic characteristics of the two populations. Even if this information were available, admission data are widely recognised to be misleading in service evalu ation, particularly in the absence of supplementary data such as length of stay.
The accompanying table is strange: N = 53 for the Priory Hospital but there is no figure given for the Charing Cross Hospital. Percentages for the Priory are lent an air of spurious accuracy by being taken to the first decimal place, but when more closely exam ined do not correspond in any way to whole numbers of patients. In contrast the figures for the Charing Cross are rounded to a whole percentage point. The letter provides no valid evidence to support its conclusions which are firmly stated as above.

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The publication of this letter in the Psychiatric Bulletin will be taken to support those who within central government and NHS management are attempting to dismantle comprehensive integrated district psychiatric services and replace them with a quasi commercial service on the disastrous US model. Patient populations in private psychiatry differ greatly from those seen by NHS services, a reason frequently given by psychiatrists for working privately.
Private psychiatry has usually recognised itself to be "complementary" and marginal to the NHS, and in fact is irrelevant to the needs of the largest and most vulnerable group of psychiatric patients.
I trust that in future material such as Dr Islam's letter will be clearly marked "advertisement feature", allowing it to be scrutinised by the Advertising Standards Authority, by whose criteria it will undoubtedly be found wanting. ROBPOOLE He does not make any attempt to consider the other more important variables like the outcome of these admissions and percentages of patients who are not offered admission on the basis of their inability to pay. There is little in his article which makes me reconsider my opinion that the "private sector caters largely for affluent, neurotic individuals ..." I too hope that Dr Islam will be able to conduct a more meaningful study which I am sure will confirm the common belief among his fellow psychiatrists about the private sector.
GIRISHC. SHETTY Ashworth Hospital Parkbourn, Maghull MerseysÃ¬de LÃOE1IHW DEARSIRS I would like to respond to Dr Rob Poole's criticisms by pointing out that these would have been appropri ate if I had assumed that my "brief research report" was a scientific paper.
In fact, I wrote a letter to the Psychiatric Bulletin, (June 1990, 14, 370) providing the readers with my clinical observations regarding the similarities between the diagnostic groups of the patients seen at the Emergency Clinics of a London teaching hospital and that of a large London private hospital with substantial NHS links.
I did not make any reference to the activity of a Professorial Department in a large London teaching hospital or that of other NHS psychiatric units.
The patient samples were collected retrospectively for one corresponding quarter of a year and the diag noses were made by consultant psychiatrists or by psychiatric registrars in charge of the emergency clinics. For the 53 new cases seen at The Priory Hospital the corresponding figure for The Charing Cross Hospital was 155.
I had tried to convey in my letter the need to con duct a prospective study on the follow-up of these patients which would answer some of the questions posed by Dr Poole and Dr Shetty.
A recent leader in the British Medical Journal stated that "evidence for the efficacy of psychiatric services (both private and public) is lacking. Unfor tunately, neither private nor public psychiatric hos pitals issue enough useful information on recovery rates to allow direct comparisons between different settings. In their absence consumer choice depends more on impressions of the care provided than on any evaluations of outcome. Private providers market comfort, convenience, and privacy; reduced waiting times, more intensive treatment; and respect for the patient. All these are qualities that could be improved within NHS facilities" (BMJ, 300, 7 April 1990, p. 892).
Considering the importance of these issues there is little literature on the outcome of patients treated both in the private and public sectors. Of the studies available only two compare the public and private practice of psychiatry. Gold & Partiger (1964) in Australia reported that "there was surprisingly little difference between the two practices". Langsley (1974) in the United States noted that his study was marked by the similarity of both demo graphic and clinical details of the two groups of patients, leading him to conclude that his research challenged "some of the myths about private practice". Young & Reynolds (1980) compared clinical and demographic data of patients treated in two state psychiatric hospitals with those of patients in the psy chiatric wards of two general hospitals and a private psychiatric hospital. The results were interpreted as indicating a greater morbidity of patients within the public hospitals.
A retrospective study by Goldney (1988) compar ing patients in private and public psychiatric facilities showed a general similarity of diagnoses in the two groups and the figures compare very favourably with my own findings.
What is needed is a serious and objective system atic evaluation of different forms of health care and Correspondence not a number of premature and politically motivated comments, which prejudge the issue. SAEEDISLAM