Assessment by doctors and nurses of deliberate self-harm

Sian Weston (Psychiatric Bulletin, February 2003, 27, 57-60) points out the differences between doctors and nurses assessing deliberate self-harm. From my experience looking at the Liaison Psychiatry service in Chester and Wirral, I can certainly confirm her findings that doctors are much more likely to refer to other doctors for follow-up. This was confirmed in a recent audit that we did locally. I feel that this finding is more accurate than the previous limited research discussed.

The reasons for this might be that inexperienced Senior House Officers want to be safe and therefore feel that an additional psychiatric opinion can aid in this process. It is also possible, however, that publication bias played a part in the previous articles, because the main aim of most of these papers was to prove that nurses' assessments are as good as doctors' assessments, a finding with obvious resource implications. In light of Sian Weston's findings, it certainly remains unclear whether we can be sure at this point that the consequences of being seen by a nurse or by a doctor are actually the same for the patients with regards to follow-up arrangements.