For years it has been recognised that there is an association between poor mental health and poor physical health. Patients with mental health problems are more likely than the general population to have physical health problems (Reference GoldmanGoldman, 1999) and are known to have an increased mortality rate (Reference Harris and BarracloughHarris & Barraclough, 1998). There are concerns that it can be difficult for people with poor mental health to receive good physical healthcare (Reference Phelan, Stradins and MorrisonPhelan et al, 2001), and also that poor physical health can interact with and even worsen mental health (Reference Kupfer and FrankKupfer & Frank, 2003; Reference Ward, Teuth and ShepsWard et al, 2003).

It remains a matter of debate as to whether it is for psychiatrists to manage physical health problems (Reference ShoreShore, 1996; Reference FinkFink, 1997; Reference KlusmanKlusman, 2001). On the one hand, the psychiatrist is often ideally placed to screen for and manage physical problems; indeed, the psychiatrist may be the only point of contact with health services for some patients. On the other hand, without further training or experience, psychiatrists may not necessarily provide the best care for patients (Reference Rigby and OswaldRigby & Oswald, 1987), and care might be better delegated to other health care professionals with an appropriate medical background — in particular, the primary care health team (National Institute for Clinical Excellence, 2002; Reference Welthagen, Talbot and HarrisonWelthagen et al, 2004).

In general, psychiatric trainees at the senior house officer level are responsible for the physical healthcare of all in-patients under their care. The Royal College of Psychiatrists provides comprehensive guidelines and learning objectives specifying training requirements in psychiatric disease. In contrast, there are few references to the role of the psychiatric trainee in assessing and treating physical health problems.

At present, discussion as to whether psychiatric trainees should provide physical healthcare for psychiatric in-patients is limited by a lack of information. This paper reports the results of a questionnaire that was sent to psychiatric trainees in the west of Scotland. The aim of the questionnaire was to clarify the amount of physical care that was being provided from day to day by psychiatric trainees, further medical training received, medical experience prior to commencing psychiatric training, and trainees’ attitudes towards the provision of physical healthcare.

Method

A questionnaire was sent out to 122 trainee psychiatrists in the west of Scotland, together with a brief letter of explanation. No time limit was set for the return of the questionnaires. The questionnaires were identified by the individual training scheme, but respondents were not asked to give their names.

Results

A total of 65 questionnaires were returned over a period of 3 months, giving a response rate of 53%. Each questionnaire item was answered by between 62 and 65 respondents. On average, trainees had been working in psychiatry for 19 months. Over half of the doctors were working in general adult psychiatry, but there were responses from all of the major psychiatric sub-specialties. Questionnaires were returned from all nine of the training schemes in the west of Scotland, potentially including 20 different hospitals.

Attitudes to the management of physical health problems

Respondents were asked whether they felt that psychiatrists at a basic specialist training level should be competent to deal with a range of physical health problems, and whether they should receive further training in those areas. Their responses are given in Table 1.

Table 1. Trainees’ attitudes to the provision of physical healthcare to psychiatric patients

	Do you feel that psychiatric trainees should be competent in the following areas?				Do you feel that psychiatric trainees should receive further training in the following areas?
Area of competency	Yes	Unsure	No	Number of respondents	Yes	Unsure	No	Number of respondents
Emergency situations	61	1	1	63	62	1	0	63
GP-type problems	46	12	6	64	42	13	7	62
Long-term healthcare	29	16	18	63	35	10	18	63
Standard physical examination	63	0	0	63	42	7	14	63
‘ Psychiatric’ medical problems	61	2	0	63	62	0	1	63
Non-‘psychiatric’ medical problems	59	2	1	62	47	7	9	63

Discussion

In general, psychiatric trainees appear to be providing a considerable amount of physical healthcare for their patients. Almost all of the trainee psychiatrists who responded to the questionnaire were expected to deal with routine general practitioner-type problems on a regular basis; if not during their nine-to-five day, then while on call. The overwhelming majority of trainee psychiatrists were expected to provide emergency care, and although medical emergencies are rare in psychiatric hospitals, it is likely that doctors would have had to provide emergency care on at least one occasion during their training.

With the exception of emergency care, the majority of psychiatric trainees are not receiving formal training in physical healthcare. Most trainees in our study reported that they made some independent attempt to keep their medical skills up to date, although this might not necessarily be a true reflection of actual practice. A large proportion of psychiatric trainees have considerable experience in other fields of medicine before entering psychiatry, and this would need to be taken into consideration if further training were planned.

Although the overall response rate was only 53%, this was biased by the extremely low response from two of the larger training schemes. The questionnaire was sent out to trainees in a single area of Scotland only, but there is no reason to suspect that the results would not generalise to other regions. The questionnaire was designed and targeted around the job of the senior house officer because it was felt that they are largely responsible for the provisions of healthcare on the hospital wards. Only three respondents (5%) said there was ‘somebody with a medical background specifically employed for [the] purpose’ of overseeing the long-term health of their patients, and there were no other comments or responses to suggest that staff other than the senior house officer looked after emergency or routine medical enquiries. Indeed, just five psychiatric trainees (8%) replied that they would ask their consultant or registrar for help in an emergency, and only two (3%) would ask for advice on non-urgent physical healthcare problems.

This study does not pretend to answer the question whether it is appropriate for psychiatrists to manage physical health problems. However, its results do suggest that psychiatric trainees are currently providing a considerable amount of physical healthcare for psychiatric inpatients in their charge. At present, this provision appears to be largely unsupervised by their consultants, and is in the absence of further training. Although not admitted to hospital for management of their physical health, psychiatric patients have high rates of medical comorbidity, and it would seem particularly important to ensure adequate physical healthcare provision for them. Perhaps it is time to ask whether the current provision is in fact adequate.

Declaration of interest

None.