Saturday, November 29, 2008 Psychiatry: A specialty relegated to the basement


November 24, 2008 at 8:52 PM EST

Jai Shah could have been any sort of doctor he wished. Even before he graduated with honours from the University of Toronto's medical school, the 30-year-old Edmonton native had earned a master's degree in international health policy from the London School of Economics, published papers and worked for the Canadian Institutes of Health Research.

Praise follows him wherever he goes. Except for last fall – when he decided to specialize in psychiatry.

“A psychiatrist?” some of his supervisors said, “But you're smart! … You're taking the easy way out … Your patients will make your life hell … Your patients will make you depressed … What a waste of talent!”

Jai Shai is a resident in psychiatry at Beth Israel Deaconess Hospital in Boston. Jodi Hilton/For The Globe and MailDr. Shah knew mentally ill people battle both their disorders and the social stigma their conditions carry. But it surprised him that psychiatrists confront a certain stigma, too.

“I'm sure the feedback has discouraged some young doctors from choosing this as their career,” said Dr. Shah, now at the Harvard Longwood Psychiatry Residency Training Program in Boston.

In fact, Susan Abbey, who heads the U of T first-year residency program in psychiatry, said the disparaging comments are “ubiquitous.”

“I don't think there's one of our incoming residents who hasn't been exposed to negative comments from family or friends or academic supervisors,” Dr. Abbey said.

Just as lawyers can face a barrage of bottom-feeder jokes, psychiatrists, both in film and real life, have long been seen as doctors of a lesser science. Even their own physician colleagues can view their patients as difficult and time-consuming. The negativity, experts say, is contributing to a national shortage of psychiatrists and shoddy care for mentally ill people.

Across the country, Canadians are unable to see a psychiatrist when they need one. A survey from the B.C.-based Fraser Institute released last month suggests the national median waiting time for psychiatric care this year is 18.6 weeks, longer than for any physical treatment.

A Canadian Psychiatric Association survey has found that even in emergency cases – where the CPA recommends a patient be admitted for acute care within 24 hours due to a “high degree of risk to self or others” – delays in some regions range from 57 hours to nearly five days.

“It's the patients who doubly suffer from the stigma,” Dr. Shah said. “First, from the social perception of their illness and then, on top of it all, from the shortage of treaters, and the gaps in care reflect the stigma within the medical profession and that contributes [to the social perception]… so it's a vicious circle.”

Studies suggest these attitudes take a toll on medicine's front lines: Mentally ill people have a tougher time finding a family doctor, are more likely to need urgent medical care and less likely to receive life-saving treatments. They're also more likely to die of conditions such as heart attacks, strokes and cancer.

At the same time, funding for mental-health research and psychiatric services has paled compared with monies doled out for physical ailments. Mental illness, meanwhile, is the No. 1 cause of disabilities in Canada and accounts for 20 per cent of all hospital admissions.

The inequities are so apparent that the Mental Health Commission of Canada has made it a top priority to fight stigma among health-care professionals, and this year the Canadian Medical Association, which represents the country's doctors, has launched a campaign to combat the stigma within its ranks.

“Doctors will be inclined to see mental illness differently than other medical illnesses … it's not like a broken bone, you don't see it clearly,” said CMA president Dr. Robert Ouellet. “We feel mental illness has not received its fair share of attention.”

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