‘What would you do if you were me, doctor?’: randomised trial of psychiatrists' personal<i>v.</i>professional perspectives on treatment recommendations

Mendel, Rosmarie; Hamann, Johannes; Traut‐Mattausch, Eva; Bühner, Markus; Kissling, Werner; Frey, Dieter

doi:10.1192/bjp.bp.110.078006

Cited by 30 publications

(17 citation statements)

References 26 publications

(30 reference statements)

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“…This is consistent with previous studies where physicians decide differently if they are in a professional role deciding for others than if they are in an existential role deciding for themselves [46][47][48]. Therefore, clinical decision-making seems to be fundamentally different when one decides for oneself or gives advice to others [49,50].…”

Section: Discussionsupporting

confidence: 90%

A European survey on attitudes towards pain and end-of-life issues in locked-in syndrome

Demertzi

Jox²,

Racine

et al. 2014

Brain Injury

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Objectives: Patients with locked-in syndrome often self-report a higher quality of life than generally expected. This study reports third-person attitudes towards several salient issues on locked-in syndrome. Methods: Close-ended survey among conference attendees from 33 European countries. Analysis included chi-square tests and logistic regressions. Results: From the 3332 respondents (33% physicians, 18% other clinicians, 49% other professions; 47% religious), 90% agreed that patients with locked-in syndrome can feel pain. The majority (75%) disagreed with treatment withdrawal, but 56% did not wish to be kept alive if they imagined themselves in this condition (p50.001). Religious and southern Europeans opposed to treatment withdrawal more often than non-religious (p50.001) and participants from the North (p ¼ 0.001). When the locked-in syndrome was compared to disorders of consciousness, more respondents endorsed that being in a chronic locked-in syndrome was worse than being in a vegetative state or minimally conscious state for patients (59%) than they thought for families (40%, p50.001). Conclusions: Personal characteristics mediate opinions about locked-in syndrome. The dissociation between personal preferences and general opinions underlie the difference in perspective in disability. Ethical responses to dilemmas involving patients with locked-in syndrome should consider the diverging ethical attitudes of stakeholders.

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Section: Discussionsupporting

confidence: 90%

A European survey on attitudes towards pain and end-of-life issues in locked-in syndrome

Demertzi

Jox²,

Racine

et al. 2014

Brain Injury

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show abstract

“…Experts tend to worry the most about missing a case that should be treated, and much less about false positives, 63 given that they may be held responsible for the negative consequences of undertreatment. 64 This is exactly why weekly monitoring, during watchful waiting, mostly by telephone, is important in a stepped care and stepped diagnosis approach.…”

Section: Problems Of Combined Stepped Care and Stepped Diagnosismentioning

confidence: 99%

Childhood ADHD

Batstra

Nieweg

Pijl

et al. 2014

Journal of Psychiatric Practice

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Since publication of DSM-IV in 1994, the prevalence of parent-reported diagnosed attentiondeficit/hyperactivity disorder (ADHD) has tripled to more than 10% of children. Although it is hard to know for sure whether ADHD is overdiagnosed, underdiagnosed, or misdiagnosed, it is argued that ADHD is especially prone to diagnostic inflation and overdiagnosis. Therefore, we propose a model of stepped diagnosis for childhood ADHD, which may reduce overdiagnosis without risking undertreatment. Calling attention to stepped diagnosis and formalizing the steps may improve its application in clinical practice.

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“…A ''wait and see'' approach often is all that is needed, but clinicians often find it difficult not to pull the trigger on diagnosis and treatment (Mendel et al, 2010).…”

Section: Stepped Diagnosismentioning

confidence: 99%

Diagnostic Inflation

Batstra¹,

Frances²

2012

The Journal of Nervous and Mental Disease

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There have been a striking diagnostic inflation and a corresponding increase in the use of psychotropic drugs during the past 30 years. DSM-5, scheduled to appear in May 2013, proposes another grand expansion of mental illness. In this article, we will review the causes of diagnostic exuberance and associated medical treatment. We will then suggest a method of stepped care combined with stepped diagnosis, which may reduce overdiagnosis without risking undertreatment of those who really need help. The goal is to control diagnostic inflation, to reduce the harms and costs of unnecessary treatment, and to save psychiatry from overdiagnosis and ridicule.

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‘What would you do if you were me, doctor?’: randomised trial of psychiatrists' personalv.professional perspectives on treatment recommendations

Cited by 30 publications

References 26 publications

A European survey on attitudes towards pain and end-of-life issues in locked-in syndrome

A European survey on attitudes towards pain and end-of-life issues in locked-in syndrome

Childhood ADHD

Diagnostic Inflation

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