Blue/Orange Rehearsal Blog 2

Tue 17 Apr 2012

Mark Twain once said “The rule is perfect: in all matters of opinion our adversaries are insane.” 

This cuts to the quick of Blue/Orange.  A Senior Consultant and Junior Doctor try to deal with a sectioned young black patient.  All the while both men are pushing for different diagnoses.  Who is right?  Are they both wrong?  When it comes to psychiatry, such matters of opinion are very common in clinical practice.  Think about the much publicised debates of Sigmund Freud and Carl Jung.

The Moveable Feast

Psychiatrists seem to order less ancillary tests (blood tests, CAT scans etc.) than other doctors.  Most branches of medicine use lots of these types of tests, both to tell doctors what they cannot know e.g. the cause of an illness, as well as to provide clarification on what they think they know before they decide to act e.g. X rays to check broken bones.  In many countries there is a legal requirement that the reason for the diagnosis should be given to the patient before any action is taken.  Psychiatrists are more likely to use diagnostic interviews, questionnaires and rating scales which measure things like symptoms and risk factors.

In the play Robert, the Senior Consultant, is working on a book about a very specific area of study.  He is very much from the “old school” of psychiatry and as a result his views as perhaps seen by some junior doctors as unorthodox, possibly outdated.  But in reality, information doesn’t have to be new to be useful.  Forty years ago, psychiatrists compared the accuracy of clinical vs. statistical prediction when it was applied to the same data.  Statistical predictions were found to be at least as accurate as the judgement of trained clinicians.  The only problem lies in reliability.  One doctor’s judgement about the same data, or patient, may vary from case to case.  Likewise, judgements may vary between clinicians.  Reliability is needed for validity.  If a doctor can’t reach the same diagnosis on two occasions when using the same data, then at least one of his decisions is questionable.  And if two doctors given the same information cannot agree, then at best one, and at worst both, will be wrong.

Reliable judgements are just one side of the story.  Clinicians vary greatly in the ways they ask their patients about illness and consequently, can get very different results.  In the course of researching the play Jonathan Race, playing Junior Doctor Bruce, discovered that some psychiatrists find certain drugs and treatments more effective than others.  It is personal opinion and choice.  Which antipsychotic has gotten them the best results?  One doctor may prescribe Haloperidol for a patient, while another may prescribe something completely different.

Did you know?  People with dual diagnosis are likely to be among the most demanding of clients encountered by mental health practitioners.  However, people with mental health problems are one of the most isolated and impoverished groups in society.

John R Wilkinson
Rehearsal Assistant
Monday 16^th April

blue/orange is on from Thu 26 Apr - Sat 12 May in the Studio.