Negative attitude in medical students towards patients with Mental Illness
A recent study published in Medical Education demonstrated that undergraduate medical students react less positively towards mentally ill patients in primary care than to patients in good health or with a chronic physical illness, such as diabetes.
Despite striving to promote knowledge and skills related to the recognition and management of patients with mental illness by the General Medical Council (GMC) and UK medical schools. Moreover, general clinical and psychiatric training had little effect on these reactions.
Concerns that the students appears to have with patients with mental illness ?
- Their perception that mental health patients will take up more time. This may be accurate as mental health care users do have higher consultation rates than the general population and take more time to evaluate these patients.
- They think that mental ill patients use more illegal drugs and they are concerned about child welfare of parents with mental illness. But substance abuse is generally found more frequently in young men with antisocial characteristics instead of schizophrenia. Children of parents with mental illness may be exposed to considerable psychosocial and genetic risks but this shouldn’t exclude the care for these patients, it should promote the health care.
- The students still have the perception that mental illness patients in the community have an
increased risk of violence. This is not true. This is a common view fuelled by media coverage. - In Schizophrenia the students presume compliance to be a bigger problem and they are less likely to undertake health promotion activities such as exercise and healthy diet.
- Students also thought that the patient with depression was deemed more likely to drink to excess than those with other diseases.
Students need to appreciate that although patients with mental health problems may, as a group, be more difficult to manage than other patient groups, this does not mean that all – or even the majority – of such patients will be.
Even when they are more difficult to manage they still have a disease comparable to somatic illness or even worse, that should be treated. On emergency rooms these patients also tend to be neglected out of fear or countertransference. Suicidal patients are often seen as a bother on ER department. Also care of their somatic illnesses tend to be under treated and neglected.
Although this study was undertaken in a single institution, Birmingham Medical School is one of the largest schools of medicine in the UK.There seems to be no reason why the results reported here should not be generalisable to all UK medical schools.
And there seems to be no reason why the results reported here should not be generalisable to other countries such as The Netherlands or the US.
How did they study this?
A sample of 1239 students from the University of Birmingham Medical School were each given one of four case vignettes, all of which were identical except that the patient involved was described as having a previous diagnosis of, respectively, schizophrenia, depression, diabetes or no illness. Students rated their level of agreement with 12 attitudinal statements relating to the vignette.
How to fight this?
Improve medical education. The authors suggest that because personal experience with mental illness lessens the negative attitude students have towards mental illness they should attend the presentation of autobiographical cases which allow the disease to be viewed within the context of an individual’s entire life. This can be accomplished by reading autobiographical books or see films such as “A beautiful mind” or talk to these patients and integrate this in the education.
What do you thinks as patient and/or physician?
Robert P Dixon, Lesley M Roberts, Stephen Lawrie, Lisa A Jones, Martin S Humphreys (2008). Medical students’ attitudes to psychiatric illness in primary care Medical Education DOI: 10.1111/j.1365-2923.2008.03183.x
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Absurdity in Healthcare « Home of the Brave
October 16, 2008 @ 7:53 pm
[…] As applied by medical students: […]
October 17, 2008 @ 6:01 am
I think it is unfortunate, but it does not surprise me. I think many nurses doctors probably have the same thoughts. I was once in the emergency room for a week due to CMV related hepatitis (no other beds aailable in the hospital). On the third night the police brought in a person who was probably psychotic. My bed was near the nursing station and I could hear the nurses and doctors making fun of the “crazy person” in the lockdown room. It was awful. I felt so bad for the ill person, and so angry that it could easily be me in that situation one day.
I have also had numerou family doctors who were less than supportive of me during depressive episodes. Even my current doctor who I really,really like has said a few really personally biased things to me about my being ill. Last year she flippantly told me I must have Borderline Personality Disorder if I had been this sick for this long. This despite every six months receiving consult notes about my MDE from my psychiatrist. She didn’t pause to think how her comment might affect me. The second last time I saw her she said something lse that had me in tears. She apologized the next time she saw me, which I found respectful, but I worry for those patients whose doctors are not reflective about how they interact with mentally ill people.
October 17, 2008 @ 6:03 am
by the way…Neil Young rocks!!! Thanks for the note.
Grote Visite 1.5 (Dutch Grand Round) « Laika’s MedLibLog
October 21, 2008 @ 5:49 pm
[…] By the way, Dr Shock has many other recent interesting posts as well and has an international reputation as medical blogger. For instance Pallimed hosting this week Grand Round refers to dr Shock as follows: Dr. Shock consistently comes up with some very interesting journal articles. I really appreciated his take on impact of medical student biases towards patients with mental illness. So you may read t… […]
October 22, 2008 @ 12:11 pm
Would some of these beliefs be those of people who just haven’t had much exposure to the mentally ill? Many people in the community have negative attitudes.
Hopefully by the end of medical school this ignorance has gone for students once they have done psychiatry placements and general practice and been exposed to people with mental illness in all areas of medicine. Not to mention the high burden of medical students who have mental illness (typically anxiety and depression)….(or issues with substances, typically alcohol, but sometimes others, caffeine perhaps??)
October 22, 2008 @ 2:23 pm
My experience is that physicians with experience with mental illness in their direct environment (relatives, parents)are interested in mental illness and are emphatic towards these patients most of the time. For the others my experience is not very positive. On ER and other wards these patients are considered a burden taking to much time and are problematic.
October 22, 2008 @ 4:15 pm
Medical environments seem to me to have more stigma and contempt than the general public. I’ve been on both ends.
Medical Students on Mental Illness « Medliorate
October 23, 2008 @ 10:00 am
[…] Negative attitude in medical students towards patients with Mental Illness [Neurostimulating Blog] […]
October 23, 2008 @ 5:29 pm
As a nurse who has had bipolar disease since puberty, I’ve experienced this sort of discrimination throughout my life. It can be extremely frustrating. I’m not surprised by this study, considering the widespread stigma against mental illness of any kind. Great post. BTW, I’m adding you to my reader–great blog.
January 2, 2009 @ 4:11 am
Hi I wrote the paper actually and we did specifically look into the effect of furthering education on medical students attitudes towards mental illness. To our suprise we found no difference in the opinions of those who had and had not completed their psychiatry and general practice blocks respectively. We also inquired (anonymously) if people had personal experience of mental illness. Its from this we found that personal experience of mental illness did lead to a more positive and emepathetic approach to those suffering with mental illness and thus our suggestion to try and recreate this experience in the teaching environment to change the way medical students are currently being taught. I hope this is of interest to you glad you liked the paper it took me ages to write so its really nice people are talking about it!!
January 2, 2009 @ 1:54 pm
Excellent suggestion, but how can we integrate this into the medical curriculum? Hope you will continue the research, busy on a paper for at least a year now if that is of any consolation. Kind regards Dr Shock
January 26, 2009 @ 5:04 pm
Well we were thinking of small group tutorials using autobiographical sources to discuss, we did put references for some of our suggested texts in the discussion section of the paper. Further research into the current small group teaching and the negative attitudes this can develop has recently been undertaken by another one of the authors of this study. Another source could be special studies modules looking into mental illness in the arts which we are currently running at Birmingham Medical School. I do understand that the latter measures will most likely appeal to those with a specific interest and may be preaching to the converted but as the study showed an interest in psychiatry does guarantee a lack of negative attitudes towards mental illness. I hope this helps answer your questions a bit, good luck with your paper I’m sure you’ll get it done in the end!!
Pharmacy students also have a negative attitude towards mental health patients | Dr Shock MD PhD
January 29, 2009 @ 12:35 pm
[…] health patients. These results were in line with the results of a previous published study with medical students: ingrained prejudices and misinformation is the rule. Mental health patients are […]