Real medicine

Abstract

A substantial part of a paediatrician's work increasingly involves caring for children and young people with mental health, developmental, emotional and behavioural problems. Over time, recognition of these aspects has redefined and broadened the notion of what classically constitutes 'Paediatrics.' This paper discusses the ways in which paediatricians and psychiatrists can support each other in this work. It highlights the role of supervision and specifically advocates for the expansion of consultation/liaison psychiatry services.

Paediatricians and psychiatrists working together: what works best?

“…Paediatricians have been documented as wanting help in clarifying diagnosis of complex patients and of comorbidities, in prescribing of psychotropic medication, in the treatment of depression and anxiety disorders and in crisis management of suicidal patients 10 24 25. Paediatricians recognise that they commonly do not have the time or expertise to manage complex patients 9 26.…”

“…This is recognised as a significant reason as to why paediatricians consider psychiatrists and CAMHS to be unresponsive to requests for help 9 25 28 29…”

“…Individual relationships need to be developed with face-to-face clinical discussion and informal meetings 25 28. There needs to be recognition and respect for differences in clinical styles and treatment paradigms, an appreciation that such differences are healthy and that each discipline can learn from the other 28 30…”

“…Measuring improved symptoms of psychological conditions is problematic for many reasons (eg, symptoms naturally change over time/difficulties in defining a control group) 7. Proposed potential targets for assessment include improved access to mental health professional care,10 decreased use of medical services,25 improved school attendance25 and improved quality-of-life measurements 7. The development of assessment tools that use patient experience would be another approach to demonstrate the value of collaborative interventions.…”

“…By being available to provide consultative advice that is perceived as helpful, psychiatrists are able to expand their input that helps create a cultural shift that values their conceptual input to clinical diagnosis and decision making above that of psychotropic prescription and the management of ‘complex patients’ 6 15 25…”