Psychiatry for all: enhancing medical practice and patient outcomes through psychiatric education for all doctors

This article emphasizes the importance of studying psychiatry for all medical professionals. Psychiatry deals with mental, emotional, and behavioural disorders, and a strong understanding of the field leads to more holistic, effective, and empathetic


Introduction
Psychiatry is the medical speciality that deals with the diagnosis, treatment, and prevention of mental, emotional, and behavioural disorders. While it may seem like a specialized field, every medical professional will benefit from studying psychiatry. The German physician Johann Christian Reil (1759Reil ( -1813 is often referred to as the "father of psychiatry" because of his significant contributions to the development of the field of psychiatry (1). Reil was a physician, anatomist, and physiologist who played a crucial role in shaping the early understanding of mental health and mental illness (1). Reil's most notable contribution to psychiatry was the introduction of the term "psychiatry" (1). In 1808, he published a seminal paper where he proposed the term "psychiatrie" to describe the medical discipline focused on the study, diagnosis, and treatment of mental disorders (1). Reil emphasized the importance of integrating the study of mental disorders into medical education and practice. His advocacy for humane treatment and a multidisciplinary approach to mental health care shows that he clearly recognized the value of psychiatric knowledge for physicians across various specialities. The following are some of the important reasons why all doctors should study psychiatry.

Abstract
This article emphasizes the importance of studying psychiatry for all medical professionals. Psychiatry deals with mental, emotional, and behavioural disorders, and a strong understanding of the field leads to more holistic, effective, and empathetic patient care. Key reasons for doctors to study psychiatry include adapting a biopsychosocial model of care, early identification and intervention for psychiatric disorders, improved health outcomes, better communication skills, combating stigma surrounding mental health, multidisciplinary collaboration, personal growth and self-care, and a more compre-hensive approach to chronic illness management. Integrating psychiatry into medical education prepares doctors for the challenges they will face in their careers, ultimately improving the quality of patient care. The practice of offering internships in psychiatry, as seen in countries like UK and Australia, should be encouraged globally to create a cohort of doctors knowledgeable in the basics of psychiatry, ultimately reducing the impact of a shortage of psychiatrists and improving overall healthcare.

A more holistic approach to patient care -the biopsychosocial model
A holistic approach to patient care emphasizes the importance of understanding and addressing the physical, emotional, social, and mental aspects of a patient's well-being. The biopsychosocial model of medical care was first proposed by George Engel, an internist and a psychiatrist (2). Engel's model highlights the importance of understanding the individual rather than focusing solely on the biological aspects of illness (3). It recognizes that psychological factors, such as emotions, thoughts, and behaviours, and social factors, such as family, culture, and socioeconomic status, also play a significant role in the development and progression of an illness. The study of psychiatry, which emphasises the biopsychosocial model, sensitises doctors and medical students and helps them gain insight into the complex interplay between mental and physical health, leading to more effective and empathetic patient care.

Early identification and intervention where psychiatric disorders present with somatic symptoms
Many psychiatric disorders, such as depressive, anxiety, and stress disorders, often manifest as physical symptoms to non-psychiatric specialists or general practitioners (4). A knowledge of psychiatry will help doctors to identify the underlying psychiatric disorder in such presentations, enabling early intervention and preventing inappropriate investigations and other forms of treatment. Depressive disorders, for example, have been shown to manifest as somatic symptoms, such as fatigue, disturbances in sleep patterns, changes in appetite, and chronic pain. These physical symptoms can often be the primary reason for a patient's visit to a primary care physician or specialist (4). A study by Kroenke et al., found that up to 69% of patients with depressive or anxiety disorders presented with somatic symptoms, emphasizing the need for physicians to be aware of the potential underlying psychiatric aetiology (4).

Failure to recognise underlying depression and anxiety leads to poorer health outcomes
Failure to recognize and address psychiatric disorders that manifest as physical symptoms can cause poorer health outcomes, decreased patient satisfaction, and increased healthcare costs (5). It has been shown that the mental state of patients prior to surgery has a significant effect on postoperative outcomes (6). For instance, patients with pre-operative anxiety and depression have been shown to have a higher risk of developing postoperative complications, such as infections and delayed wound healing (6). Depression and anxiety have consistently been shown to be associated with increased mortality and adverse outcomes in patients who have experienced myocardial infarction or stroke (7). There is evidence that a positive mental state promotes healing and reduces the recovery time (8). Norman Cousins, in his classic book "Anatomy of an Illness as Perceived by the Patient", describes how to overcame a debilitating condition, ankylosing spondylitis, through the use of unconventional methods such as laughter, positive emotions, and self-advocacy in his medical treatment (8). The study of psychiatry gives a doctor the skills to identify underlying depression and anxiety and to take early action to improve outcomes. It will also give them tools to teach their patients to have a more positive outlook on their health status.

Effective communication is an essential skill for any healthcare professional
By studying psychiatry, doctors and medical students develop better listening, empathy, and rapport-building skills, which foster strong therapeutic relationships with their patients (9).
These skills are crucial in building trust, addressing patients' concerns, and ensuring adherence to treatment plans. A study by Street et al., found that patient-centred communication is linked to improved patient satisfaction and health outcomes (10). By studying psychiatry, doctors gain valuable insights and develop specific communication skills that apply across various medical disciplines. Good communication is an essential tool for a psychiatrist and the discipline emphasizes training in active listening, empathy, and compassion, which are essential for understanding patients' needs and concerns. Psychiatry also focuses on building rapport, recognizing nonverbal cues, developing cultural competence, addressing mental health issues, and employing techniques such as motivational interviewing techniques which are useful in changing behaviours (11).

Addressing the stigma surrounding mental health
A major challenge faced by individuals with mental illnesses is the stigma associated with their conditions. Stigma leads to reluctance in seeking help or treatment, lack of understanding by family, friends, and co-workers, and even bullying, physical violence, or harassment. The stigma associated with mental health issues has a negative impact on the treatment of physical illnesses. Non-psychiatric specialists or general practitioners with poor knowledge of psychiatry may attribute physical symptoms in patients with a history of mental illness to their psychiatric problems and ignore or miss signs of an underlying physical illness, sometimes with fatal consequences. However, when such doctors have a deeper understanding of mental health issues, they can help dispel misconceptions and educate others about the prevalence and treatability of mental disorders (12). Further, they will be more mindful of the language they use when discussing mental health, avoiding stigmatizing terms, and promoting a more inclusive and compassionate environment.

Multidisciplinary collaboration
Healthcare is becoming increasingly multidisciplinary, and doctors often work in teams with specialists from various other fields related to medicine (13). In psychiatry, patient assessment and care are done through multidisciplinary team meetings. The team includes psychiatrists, psychologists, social workers, occupational therapists, nurses and other professionals, each contributing their unique expertise. By working in a psychiatry multidisciplinary team, doctors learn to appreciate and use the diverse skills and knowledge of professionals from different disciplines, leading to more comprehensive and effective patient care.

The role of psychiatry in chronic illness management
Chronic illnesses, such as diabetes, heart disease, and cancer, often have psychological components that can affect the patient's overall health and treatment adherence. By studying psychiatry, doctors and medical students can better understand the psychosocial aspects of chronic illness management and provide more comprehensive care for their patients. Research by DiMatteo et al., found that patients with poor mental health were more likely to be non-adherent to treatment regimens, highlighting the importance of addressing mental health in chronic illness management (15).

Personal growth and self-care
The mental well-being of healthcare professionals, particularly doctors, has increasingly become a topic of concern in recent years (16). The demanding nature of their profession, coupled with the emotional toll of caring for patients, places doctors at a higher risk of experiencing mental health issues. In this context, the study of psychiatry helps doctors manage their own mental health more effectively. Studying psychiatry equips doctors with a deeper understanding of mental health disorders, their symptoms, and effective treatment strategies. This knowledge enables doctors to identify early warning signs of mental health issues in themselves and their colleagues. By recognizing symptoms early, doctors can seek help and intervention, potentially preventing the escalation of mental health issues and the associated personal and professional consequences. Psychiatry emphasizes the importance of healthy coping strategies for managing stress, anxiety, and other emotional challenges. By incorporating these strategies into their daily lives, doctors can better manage their own mental health and mitigate the negative effects of stress. Examples of such strategies include mindfulness-based practices, cognitive-behavioural therapy techniques, and relaxation exercises, which have been shown to effectively reduce stress and anxiety in healthcare professionals. A study by West et al., found that interventions targeting self-care and stress management can reduce burnout among physicians and improve well-being (16).

How can doctors learn psychiatry?
Incorporating psychiatry into medical education, doctors and medical students develop a well-rounded understanding of the biopsychosocial model of health, which considers the biological, psychological, and social factors that contribute to illness. Medical schools are increasingly incorporating psychiatry into their curricula to better prepare students for the challenges they will face in their careers (17). A study by Menezes et al., found that exposure to psychiatry during medical school was associated with more positive attitudes towards mental health and improved clinical skills (17). In Sri Lanka, we now have a common curriculum and at least a total of two-month clinical attachment for all undergraduates in state medical schools. The next level of education would be an internship in psychiatry after graduating, which would give doctors practical experience in diagnosing and treating a wide range of mental health conditions. By working alongside experienced psychiatrists, interns gain essential skills such as patient assessment, treatment planning, and therapeutic intervention. This hands-on experience helps develop confidence and competence in handling psychiatric cases, ultimately improving the quality of patient care. The UK and Australia are two countries that offer internships in psychiatry (18,19).
It is hoped that Sri Lanka, too, will introduce this practice in the future. A cohort of doctors knowledgeable in the basics of psychiatry would help reduce the impact of a shortage of psychiatrists and improve the overall healthcare of the country (20).