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Professionalism in Mental Healthcare
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Book description

In mental health, as in other medical disciplines, the role of the professional is changing. The availability of information, enhanced roles of other healthcare professionals and changes in training have altered the doctor-patient relationship and left professionals accountable to the needs of clients, politicians, policy makers and funding agencies. This book seeks to redefine the professional role of the specialist mental health worker by bringing perspectives from leading experts from both developed and developing countries, and also from a wide range of professionals in the field of law, medical ethics, education and medical leadership. Uniquely, it also looks at the views of patients and next-generation psychiatrists. It will be of interest to those involved in providing mental healthcare as well as those responsible for health policy initiatives and training.

Reviews

'Bhugra and Malik have brought together an interesting group of essays on recent changes in professionalism in psychiatry, well worthy of the attention of anyone interested in the stresses and strains affecting mental health workers.'

Source: Journal of Mental Health

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Contents

  • Chapter 7 - Professionalism
    pp 70-81
  • View abstract

    Summary

    Experts in any field develop their expertise using both their training and experience. The nature of the expertise of the profession is a key essential of professionalism. The key to understanding professionalism is on two levels: first, what constitutes professionalism, and second, what gaps might highlight what a professional lacks, thus looking at expertise and professionalism both positively and negatively. In understanding the experiences, explanations and expressions of illness from the patient, the expert can engage with the patient, find common ground to explore, agree on goals of treatment and management plans and then keep these under review in regular discussions with the patient. This chapter shows that attitudes and professional attributes can be changed. Areas of expertise in psychiatry include culture; the ability to understand, co-ordinate and work co-operatively to provide comprehensive mental healthcare; the ability to understand ethical practice; and effective communication and education.
  • Chapter 8 - Can professionalism be taught? Lessons for undergraduate medical education
    pp 82-91
  • View abstract

    Summary

    In an increasingly shrinking world, the contacts between cultures and communities are becoming closer. The economic and social impact of the process of globalization can be understood at several levels - that of the individual, the family, culture, society, etc. - and different systems influenced at different speeds. This chapter examines some of the components of globalization which, in recent years, became somewhat more useful to all, possibly because of the realization that a variety of world's problems can only be resolved jointly. Commoditification is a new word indicating the gradual conversion of all interactions and activity into economic terms. Thus, healthcare is handled as a commodity in a similar way to sugar, cotton or other commodities. Migration across borders is more visible and its effects are observed with more attention than migration within borders.
  • Chapter 9 - Patient expectations from psychiatrists
    pp 92-100
  • View abstract

    Summary

    This chapter points out the altruistic service ethic in which the expertise of the professional was secured for society through contract with society. Changing social and economic circumstances and expectations mean that altruistic behaviour itself may need to be redefined. Professionalism and its values can be criticized as being self-serving, especially if self-regulation is included in the equation. The chapter discusses issues with regard to medicine, and law takes extreme degree of the role of expertise and peers, rather than simply employing external standards. It asserts that the law has built on an image of medical professionalism a particular model of healthcare law that assumes and promotes the moral basis of medical practice. The chapter explores what can be learnt about the nature of professionalism through the lens of the law. It shows how the law has been used to reinforce professional power.
  • Chapter 10 - Teams and professionalism
    pp 101-114
  • View abstract

    Summary

    The American healthcare system has several types of providers, leading to plethora of minisystems. Working with each of these systems provides specific issues of definition, training and delivery of services. In spite of large proportion of the gross domestic product (GDP) being devoted to healthcare delivery, approximately one-sixth of the population is uninsured and has access only to emergency treatments. This chapter provides a historical account of development of the healthcare system in the United States and the role of various reports and organizations in defining medical professionalism. Changes in organized medicine in response to the demands of society and changing public expectations have led to revisit the components of medical professionalism. The chapter focuses on the broad aspect of medical professionalism. It reviews how medical professionalism has evolved to its present state in the United States and makes recommendations for its ongoing survival.
  • Chapter 11 - New professionalism
    pp 115-126
  • View abstract

    Summary

    In the past two decades, a run of highly publicized medical scandals in the UK have affected the reputation of the medical profession. Beginning with Bristol, it was the cumulative effect of several such scandals. This chapter begins by considering what constitutes professionalism in medicine. It then looks at the recent history of medical professionalism in the UK and concludes that, whilst one have reached a position in which the regulatory framework is modern and potentially robust, there is still much to be done to ensure that professionalism is embedded deep within every doctor, part of their identity. The professionalism advanced by the General Medical Council (GMC) has four main elements: the foundation, the standards themselves; compliance mechanisms mainly through regulation and contracts of service; the responsibility for internalizing the professional standards primarily through medical education; and the moral obligation on professional institutions.
  • 12 - Medical professionalism in the new century
    pp 127-139
  • View abstract

    Summary

    The movement for Global Mental Health is a significant step forward in the delivery of healthcare across the globe. This chapter argues that in low- and middle-income countries, where resources are limited, the role of the psychiatrist may carry higher level of non-clinical responsibilities, such as supervision and training, rather than direct clinical contact. It suggests that, under these circumstances, psychiatrists should be supporting other types of mental healthcare delivery through primary care workers of different specialties. The chapter discusses the barriers to closing the treatment gaps. It focuses primarily on the availability and distribution of specialist human resources. The term 'psychiatry' in this chapter refers both the medical and other clinical specialties concerned with mental healthcare (notably, psychiatric nursing, clinical psychology and psychiatric social work). The chapter considers the strategies through which psychiatry can, as it were, reinvent itself for the future.
  • Chapter 13 - Ethical foundations of professionalism
    pp 140-151
  • View abstract

    Summary

    This chapter focuses on professionalism in psychiatry that is important to recall that unprofessional conduct by psychiatrists taints and undermines the trust that our patients have in us as individual psychiatrists as well as in the discipline of psychiatry and medicine in general. The Australian approach to professionalism is based on international standards of professional conduct in medicine and psychiatry. However, Australian psychiatry has been influenced by instances of unacceptable care, in which patients received care was neither medically competent nor professional. Australians seeking healthcare currently do so through public or private healthcare systems, and the universal public healthcare system is known as Medicare. Australians have historically demonstrated some indifference towards those institutionalized with mental illness, and in this context there have been a number of instances of institutional exploitation of mentally ill patients.
  • Chapter 14 - Training in professionalism
    pp 152-162
  • View abstract

    Summary

    This chapter addresses the question of whether professionalism can be effectively taught, by examining what it means to teach professionalism, proposed strategies to teach it, evidence of effectiveness of interventions aimed at teaching or improving professionalism and evidence of ability to identify or predict unprofessional behaviour. In one of the primary texts on professionalism education, Hafferty notes that professionalism lies in an interface between possession of specialized knowledge, and using that knowledge for the betterment of others'. Learning the professionalism of Hafferty and Smith occurs in the culture of medical school and residency, where examples, narratives and role modelling occur. To improve this learning would require changes in the culture of medical schools. In addition to the efforts to teach professionalism to all students, many schools have programmes specifically to identify, presumably for the purpose of remediation, and students with unprofessional behaviours.
  • Chapter 15 - Expertise and medical professionalism
    pp 163-174
  • View abstract

    Summary

    Two significant people at the core of therapeutic encounter are the patient and the psychiatrist. The therapeutic encounter can establish a diagnosis and devise a management plan. The encounter lies at the core of clinical judgement. This chapter highlights the issues related to patient expectations of psychiatrists. A major task of the psychiatrist as a clinician is to come up to and understand what the patients and their carers expect from them. Patient expectations of the therapeutic encounter and what they want from their psychiatrist has to be seen in the context within which it is being carried out. Keeping up-to-date with knowledge, developing and setting standards and ensuring that these standards are met and kept, being ethical and possessing excellent communication skills are the key characteristics which patients and carers expect of their psychiatrists.
  • Chapter 16 - Leadership and professionalism
    pp 175-187
  • View abstract

    Summary

    The challenges of professionalism are related to changing public and patient expectations, increased costs, conflicts of interest and consumerism. This chapter talks about teamwork. The essence of teamwork is the model used for crew resource management. Teams have been around for centuries, but healthcare teams are relatively new. They contrast with familiar congenial work groups that constitute the basic units of all hospitals. The integration of true medical teams into healthcare in several countries has occurred to varying degrees with different results. In the United States, the Accreditation Council for Graduate Medical Education (ACGME) has defined six competencies which form the basis of physician training. Two models that explain medical student cynicism include: the intergenerational model and the professional identity model. Teams serve the purpose of self-preservation by encouraging physicians to honour their ultimate fiduciary avowal, and to work co-operatively for the greater good of society.
  • Chapter 17 - Professionalism and psychiatry
    pp 188-193
  • View abstract

    Summary

    The healthcare professions have evolved over time, and consequently professional responsibilities have changed and become more technical in nature. Professionalism has a long history of being based on a defined set of values, and during the twentieth century professional autonomy was clearly the most important value among the healthcare professions, particularly among physicians. The practice of professionalism can provide continuity and enable healthcare providers to assist their colleagues and patients during a time of shifting professional values. Values provide the basis for developing a framework for the new professionalism of the twenty-first century, developed from the perspective of all four entities involved, including the healthcare provider, the individual patient, the healthcare system and society as a whole. Healthcare practitioners will place an emphasis on social justice and solidarity with patients and society, and honour and integrity will be the hallmarks of the new professionalism.

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