Aims and MethodTo determine the opinions of psychiatrists on mental illness among themselves and their colleagues a postal survey was conducted across the West Midlands.ResultsMost psychiatrists (319/370, 86.2%) would be reluctant to disclose mental illness to colleagues or professional organisations (323/370, 87.3%). Their choices regarding disclosure and treatment would be influenced by issues of confidentiality (n=245, 66%), stigma (n=83, 22%) and career implications (n=128, 35%) rather than quality of care (n=60, 16%).Clinical ImplicationsThe stigma associated with mental illness remains prevalent among the psychiatric profession and may prevent those affected from seeking adequate treatment and support. Appropriate, confidential specialist psychiatric services should be provided for this vulnerable group, and for doctors as a whole, to ensure that their needs, and by extension those of their patients, are met.

-A postal survey of 3,512 doctors in Birmingham was carried out to assess attitudes to becoming mentally ill. The response rate for the questionnaire was 70% (2,462 questionnaires). In total, 1,807 (73.4%) doctors would choose to disclose a mental illness to family and friends rather than to a professional. Career implications were cited by 800 (32.5%) respondents as the most frequent reason for failure to disclose. For outpatient treatment, 51.1% would seek formal professional advice. For inpatient treatment, 41.0% would choose a local private facility, with only 21.1% choosing a local NHS facility. Of respondents 12.4% indicated that they had experienced a mental illness. Stigma to mental health is prevalent among doctors. At present there are no clear guidelines for doctors to follow for mental healthcare. Confidential referral pathways to specialist psychiatric care for doctors and continuous education on the vulnerability of doctors to mental illness early on in medical training is crucial.

based on these parameters, the expected survival of our We have used a formal transplant protocol to select transplanted patients was calculated. Although we appatients with alcoholic liver disease (ALD) for transplied the model to a different population, the observed plantation. We retrospectively analyzed all the patients actuarial survival in the transplanted patients was with ALD who were referred specifically for transfound to be better than their expected survival (P°plantation to our Liver Unit between 1987 and 1994. Pa-.001). Our protocol was useful in selecting suitable patients were selected for liver transplantation if they had tients with ALD for liver transplantation, which resulted end-stage liver disease and had remained abstinent from in significant survival advantage with low recidivism the time they were medically advised to stop alcohol rate. (HEPATOLOGY 1997;25:1478-1484.) intake. Of the 180 patients referred for transplantation, 43 (none of whom were transplanted) had case records insufficiently complete for full analysis; this may bias Alcoholic liver disease (ALD) is currently the most common the analysis. Of the remaining 137 patients, 39 were indication for liver transplantation in the USA while it constitransplanted and 4 were awaiting transplantation at the tutes less than 5% of liver disease patients who receive transtime of analysis. Of the patients who were not accepted plantation in the UK. 1-3 Recent improvement in results of for transplantation, 13 died during the assessment, 7 liver transplantation for ALD 4,5 has left little doubt about the were considered to be unlikely to survive the procedure, value of this therapy for patients with end-stage alcoholic 29 were found to be medically unsuitable, 16 psychologi-cirrhosis; however, there is no consensus about the criteria cally unsuitable, 7 patients refused the offer of trans-needed to select the patient for this therapy and the ideal plantation, and an additional 19 either showed clinical timing for this procedure. 6,7 This is partly because of the fact improvement or were considered too well for trans-that natural history of this disease depends on patient's abilplantation. Special investigations, such as brain com-ity to abstain from alcohol. 8,9 Controversy also surrounds the puterized tomography (CT) scan and echocardiograph, ethical issues involved as some groups regard this disease as changed the clinical decision to transplant in only a largely self inflicted. 10,11 In the face of significant recidivism, small number of cases (4% and 5%, respectively). Nine of additional objections may come from a public that not only the transplanted patients died and the remaining were has indirectly to bear the high cost of liver transplantation followed up for a median of 25 (range, 7-63) months. One but also has to provide organs for this procedure. In the Oreyear actuarial survival for the transplanted patients was gon report, assessing the public opinion about the health care 79%, for those considered too sick was 0%, for medicall...

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