Psychiatrists' attitudes to physical examination of new out-patients with a major depressive disorder

Abstract

This survey examined Scottish psychiatrists' attitudes to physical examination and appropriate investigations in the routine assessment of new out-patients with a major depressive disorder. A discrepancy exists between current opinion towards and actual practice of physical examination in the assessment of new out patients with depression. Numerous obstacles to performing investigations were identified including lack of time, inadequate consulting rooms, lack of equipment and lack of chaperon. The many obstacles identified are considerable but not insurmountable. Missed diagnoses may have adverse consequences for patients as well as medico-legal implications.

Let's Get Physical! A Study of General Practitioner's Referral Letters to General Adult Psychiatry — Are Physical Examination and Investigation Results Included?

“…1 Despite these issues, it is unclear who should undertake the physical investigations of patients presenting with psychiatric symptoms. A survey of attitudes towards physical examination and appropriate investigations in the routine assessment of new outpatients with major depressive disorder 3 found that 90% of consultant psychiatrists believed that physical examination was at least sometimes necessary but that it was rarely done. The most common reason given for not performing a physical examination was an assumption that the General practitioner (GP) had already done it.…”

Review: Do deficits in cardiac care influence high mortality rates in schizophrenia? A systematic review and pooled analysis

“…There is also no culture of ‘beyond routine’ medical care for people with current or past mental ill health. In addition the abilities of psychiatrists to look after physical health of patients is at best underdeveloped ( Garden, 2005 ; Krummel and Kathol, 1987 ; Mitchell et al, 1998 ; Phelan and Blair, 2008 ). For example preventive services are provided on approximately 11% of psychiatric consultations ( Daumit et al, 2002 ).…”

A survey of psychiatrists’ attitudes towards the physical examination

“…practical obstacles such as shortage of time and equipment, concerns about the re-traumatising effect of the examination on patients who have been abused, a degree of examination 'skill atrophy' which may occur as trainees progress through psychiatric training and the general attitude that competency in this area is beyond the repertoire of skills that a psychiatrist should possess (Craddock et al, 2008;Gabbard & Nadelson, 1995;McIntyre & Romano, 1977;Mitchell et al, 1998;Read & Bentall, 2012). Other factors could include the lack of clear gold standards for PE, a misplaced faith in the value of routine investigations, an aversion to performing the examination because it can appear at odds with the other therapeutic aspects of the relationship between the patient and the psychiatrist and, in some cases, a fear of exacerbating the patient's level of agitation and aggression (Murray & Baillon, 2013).…”