How well do Australian medical schools prepare general practitioners to care for patients with mental disorders? Deborah Sahhar and Daniel O’Connor
TEACHING, TRAINING and FURTHER EDUCATION
Objective: The purpose of the present paper was to map the mental health workloads of general practitioners (GPs) , and to determine GPs’ views of the adequacy of their undergraduate training in psychiatry. Methods: Twenty-nine GPs who had graduated since 1980 from an Australian medical school provided data on 339 consecutive adult patients with conspicuous psychological disorders. After listing their patients’ problems and management plans, doctors rated the value of their undergraduate teaching in preparing them for this task. Results: Depression, anxiety and substance abuse accounted for 71% of reported cases. Virtually all patients were given some psychologically orientated treatment. Only half were prescribed a psychotropic medication. Nineteen of the 29 doctors wished that they had received more training in counselling. Conclusions: In an earlier survey it was found that Australian and New Zealand medical school curricula focused largely on the diagnosis and pharmacological management of psychosis and depression. The GPs in the present study most commonly applied psychologically orientated treatments of anxiety, depression and substance abuse. It is proposed that medical schools provide tuition to medical students in counselling. Key words: counselling, medical school, mental disorder, primary care, university.
Australasian Psychiatry • Vol 12, No 1 • March 2004
Deborah Sahhar Consultant Psychiatrist, Caulfield General Medical Centre, Melbourne, Vic., Australia. Daniel O’Connor Professor of Psychiatry of Old Age, Department of Psychological Medicine, Monash University, Melbourne, Vic., Australia. Correspondence: Professor Daniel O’Connor, Kingston Centre, Warrigal Road, Cheltenham, Vic. 3192, Australia. Email: Daniel.OConnor@med.monash.edu.au
ental disorder is common. In the recent National Survey of Mental Health and Well-being, nearly one in five adult Australians had experienced an anxiety, depressive or substance abuse disorder in the previous 1 year. More specifically, 10% had met criteria for an anxiety disorder, 8% for a substance abuse disorder and 6% for depression.1
General practitioners (GPs) provide far more care to such patients than specialists. In the same survey, 49% of persons with a depressive disorder had consulted their GP for a mental health problem in the last year compared with 12% who consulted a psychiatrist.2 Mental disorder accounts therefore for a substantial proportion of GPs’ workloads. In an earlier study of Australian GP morbidity patterns, psychological problems arose at least once in 9% of all consultations and accounted for 7% of all registered problems.3 If undergraduate and postgraduate educational programmes are properly targeted and effective, young GPs should possess the necessary knowledge and skills to meet this challenge. But do they?
In an earlier study, we reported that in 1996 Australian and New Zealand medical students received an average of 353 h (range: 279–454 h) of tuition from departments of psychiatry, mostly in the form of clinical attachments.4 With respect to content, psychotic illness accounted for 23% of formal teaching hours, depression for 26% and substance abuse for 35%. Psychological therapies were covered in an average of only 7 h (range: 1–17 h). The therapies taught included an eclectic mix of counselling, relaxation training, cognitive therapy and family therapy, depending on tutors’ interests and skills. These observations prompted us to enquire if recently graduated Australian GPs believed that their undergraduate education had equipped them adequately for the kind of psychological disorders they encountered in day-to-day practice. To address this, we questioned 29 local doctors about their...