Sushruta Journal of Health Policy & Opinion

Walking for mental health and well-being

Nandini Chakraborty — Wed, 06 Mar 2024 00:00:00 -0500

Walking is one of the easiest ways to keep healthy and well. It does not require
technical skill or complex equipment. It can be fitted in flexibly into personal
routines. It is a low impact activity, both on the pocket and the knees but deep
in its positive impact on both mind and body. It fosters a touch with nature and
builds spaces for reflection and self-discovery. It can be done solo, in families,
with friends or colleagues. It is possible to start out with short trails and
extend horizons gradually.
This article shares stories from personal and professional experiences. As a
psychiatrist, I could not recommend walking enough, for the extensive
benefits it can have on people’s lives both physically and mentally.

Sexual Misconduct in the Health Services

Rajinder Singh — Wed, 06 Mar 2024 00:00:00 -0500

Medicine has been long considered a noble profession. Nobility in medicine is not obsolete; the selflessness, courage, self-sacrifice, and altruism on gallant display in the response to COVID-19 reassure that at its core, this ethic of egalitarian service remains intact and deeply established in the DNA of physicians worldwide.¹ However, a rising rate of reported sexual misconduct in the UK NHS is putting both vulnerable patients and learners at risk of long-term physical and mental harm.² Sexual misconduct is not only devastating for the victims, but by making the workplace unsafe for women, perpetrators make the workplace unsafe for patients.

From the Frying Pan to the Fire - Life as a Foundation Year One

Triya Anushka Chakravorty — Wed, 06 Mar 2024 00:00:00 -0500

Reflections on the trials and tribulations of a first year junuior doctor - the highs and the lows.

Breaking Stigmas, Forging Paths:

Sukanya Bhattacharyya — Wed, 06 Mar 2024 00:00:00 -0500

In the corridors of Leicestershire Partnership NHS Trust, I embarked on a transformative journey in
psychiatry, one that not only shaped my professional trajectory but propelled a fervent resolve to
combat entrenched stigmas surrounding mental health. Guided by the compassionate mentorship of my
clinical supervisor, my clinical attachment became the crucible in which my motivation to pursue
psychiatry as an international medical graduate (IMG) was ignited.

Reducing Burnout, Suicide & Wellbeing among Healthcare Professionals:

Nagina Khan — Wed, 06 Mar 2024 00:00:00 -0500

Recently the lack of well-being, higher rates of burnout and reports of suicide in healthcare professionals have become an area of concern for organisations. Physician and nurse suicides are a worry and subject of increasing ‘professional and public health interest. Despite good resources to help others, healthcare workers are sacrificing their well-being. Moreover, systemic barriers by organisational culture and policy are often preventing self-care or help-seeking actions.

Sushruta – Ancient Medical Practitioner Ahead of his Time

Rajeev Gupta — Wed, 06 Mar 2024 00:00:00 -0500

As a medical doctor with 35 years of experience as a modern medical practitioner, I know how modern medical science teaches an organ and system-based approach learning building up into a disease-based approach to the treatment. This is a popular system and most of us just follow the system, however there are learning from the old Indian system of science with different approaches, such as emulated by the writings of Sushruta was one of the ancient Indian surgeon and physician who impressed me. He was ahead of his time in thinking and has written several treatises, so as to share the knowledge widely.

Creativity and Wellbeing

Prof. Geetha Upadhyaya, OBE, MBBS., MD., Ph.D., D.Lett., MBACP — Wed, 06 Mar 2024 00:00:00 -0500

tbc

When Doctors Lie

Chak Lam Ip — Wed, 06 Mar 2024 00:00:00 -0500

tbc

Forensic Psychiatry in the Quisling, Hamsun and Breivik Trials

Robert M Kaplan MBChB FRANZCP MA MPhil — Wed, 06 Mar 2024 00:00:00 -0500

The 2011 trial of Andreas Breivik for the mass murder of 69 Norwegian adolescents (plus eight people in an earlier bombing) was dominated by intense debate about his sanity, both in the court and public arenas. Similar controversies arose in two previous high-profile cases: the 1945 trial of the Norwegian collaborator Vidkun Quisling and the 1946 trial of the Nobel Prize winner Kurt Hamsun. Quisling, Hamsun and Breivik were all required to have psychiatric assessment. The findings were intensely disputed. The first assessments produced results the public found unacceptable. After a lengthy and controversial examination, Hamsun was exempted from a criminal trial but had to face a civil procedure in which he lost most of his savings. The public reaction in Breivik’s case went the other way: that he could be exempt from punishment by psychiatric illness caused such fury that legal protocol was overturned, and he was assessed again, this time producing a finding that all found satisfactory. Psychiatric issues in the three trials reviewed show remarkable symmetry, although also with some differences. Issues raised at these trials are the role of public pressure, the conflict between the belief that the perpetrators had to be mad to do what they did and the desire that they not escape due to punishment by psychiatric confinement and the recurrent problem in forensic assessment of assessing extreme overvalue beliefs. The forensic aspects at the trial of Peter Sutcliffe show that these issues were not unique to the Norwegian legal system.

Short Introduction to Anger Management

Nandini Chakraborty — Wed, 06 Mar 2024 00:00:00 -0500

tbc

A Multiprofessional Survey on the Role and Impact of Medical Associate Professions in the NHS

Tue, 26 Mar 2024 00:00:00 -0400

Background: With the global scarcity of the healthcare workforce, innovations in healthcare professional (HCP) roles include the model introduced in the 1960s in the USA of medical associate professionals (MAPs). Since 2003 in the UK, MAPs had a scope of practice defined by local employers. In 2024, the UK Parliament passed a resolution to bring the MAPs under regulation by the General Medical Council. However, multidisciplinary team and public awareness of MAPs have come under scrutiny, due to uncertainties around roles, unmonitored expansion of scope of practice, patient safety concerns, and competition for jobs and training with doctors.

There is a need for rigour in exploring the opinions of the whole spectrum of HCPs, especially locally employed doctors (LEDs), Specialty and Associate Specialities (SAS) and international medical graduates (IMGs) who not only make up a large cohort of doctors in the UK but work closely with MAPs and support their prescribing and ordering investigations functions.

Aim: Designed by a multi-professional working group, an online survey of HCPs was conducted to explore the role of MAPs in patient care, and how workforce plans around the roles align with the roles, responsibilities, and training of doctors.

Findings: A total of 583 responses were collected which included consultants (43%), postgraduate doctors in training, General Practitioners, LEDs, IMGs (75%), nurses, and allied health professionals.

Role: 53% of respondents were uncertain of the specific role of MAPs within the team; 43% agreed primary roles of MAPs involved delivering specific, well-defined skill-based services, reducing workload (20%), and providing continuity (19%). 89% emphasised the importance of a clear distinction between the roles of doctors and MAPs.
Patient Safety: 77% agreed that MAPs currently may pose a risk to patient safety. 89% recognised the risk associated with MAPs working beyond their scope. 69% agreed with the need for a competency framework for MAPs.
Supervision: 75% expressed concerns about the increased clinical risk and burden faced by doctors in supervisory roles.
Impact on Doctors: 69% reported reduced job prospects and 67% reduced training opportunities.
Regulation: 74% agreed with regulation by an independent regulator, not the GMC.

Free text: The analysis of free-text comments revealed a predominantly negative sentiment regarding the role of MAPs. Concerns about patient safety, lack of proper training, additional workload implications for doctors, the potential for misrepresentation, the erosion of training opportunities for doctors, the risk of scope creep, and confusion among patients.

Conclusion: Innovation in healthcare professional roles and functions is key to supporting the human resource shortage in health systems. The results of this survey from Multiprofessional respondents including IMGs, suggest that caution is required in how roles are positioned to the public, to avoid blurred lines of responsibility or interchange between professional roles, and to avoid confusion and consequent risk to the public. MAPs need a robust national framework of competencies, an independent regulator for licensing, and support doctors but not compete for resources, jobs, and training opportunities.

Medical Associate Professionals in the UK

Professor Indranil Chakravorty MBE PhD FRCP (Lond, Edin) — Thu, 14 Mar 2024 00:00:00 -0400

Anyone who has any connection with the world of social media will be aware of the ‘storm in a teacup’ that has been brewing in the last few months with Medical Associate / Assistant Professionals (MAPs) in the UK as Parliament debated and swiftly passed legislation¹ related to their regulation by the UK General Medical Council. In its supporting statement, the UK Minister for Health² specified,

‘Physician associates work under the supervision of doctors taking medical histories, carrying out physical examinations, performing some medical procedures and analysing test results. Anaesthesia associates review patients before surgery, initiate and manage medications, administer fluids and blood therapy during surgery, and ensure there is a plan for patients following their operation. Both roles can work autonomously, but always under the supervision of a fully trained and experienced doctor.’

The legislation was passed in the UK Parliament in Feb24 and will be in force from Dec’24.

The British Association of Physicians of Indian Origin (BAPIO) is leading a survey ¹⁷and workshop designed to have a 360-degree review of the impact of MAPs on training and career progression for all doctors, including the missing voice of several thousands of doctors who are not in formal training, are locally employed on shorter-term contracts, are considered as speciality doctors by the GMC. A vast proportion of these doctors are international medical graduates, and a significant proportion belong to cohorts who are under-represented in leadership positions (including those that were previously considered from Black or minority ethnic groups). The workshops and focus groups will include representation from all under-represented groups of doctors across the spectrum, patient representatives, nursing, and allied healthcare professionals who form an integral part of the MDT, medical leaders, higher education institutions, NHS workforce Training and Education and NHS employers. The results of the independently facilitated focus groups and survey results will be published with recommendations for all stakeholders in May 2024, and aim to provide a framework for action, reflecting consultation and views of the whole healthcare profession.