Through strong involvement in teaching, I have been fortunate to meet psychiatrists and trainees with many different perspectives. I learn something new on every course I run. Having taught formulation and management in psychiatry for several years, I realise that psychiatrists have to start thinking differently about approaching patient assessment and management. One must think like a detective; asking questions and searching for evidence, especially when outcomes are not achieved (like the TV character Dr House). Do not rely on easily apparent cop-out diagnoses (chronic schizophrenia, treatment resistance, personality disorder etc.) without considering the bigger picture. Try it out for yourself and you will be surprised with what you find.
Basic principles that one has to keep in mind:
1. Explore, do not assume – Hypothesis Based Interview
2. Synthesise and generate hypotheses – Formulation Matrix
3. Strategise and implement – Strategic Decision Making Paradigm
This forms the basis of the Psych Scene face-to-face courses where case studies are used to show how the approach is applied. The following video covers the above in more detail and provides a great introduction to Formulation and Management, changing the way you practice psychiatry. This will be used in future posts to demonstrate ways to approach complex cases.
Click on bottom right corner (Tube) to view on large screen mode.