Do we need a wider survey of physical healthcare provision for psychiatric patients?

Very few of us, I suspect, will have been surprised to read that there is inadequate recording of physical health parameters in psychiatric notes, but we should still be disappointed to learn of Dr Greening’s findings (Psychiatric Bulletin, June 2005, 29, 210-212). However, in failing to reflect upon the contribution of other professionals I am concerned that this study invites a distorted view of physical healthcare provision as a whole, which surely should be the main issue for our patients.

All psychiatric patients should be encouraged to register for and utilise primary care services, and this is especially so for rehabilitation for patients for who it is part of returning to a ‘normal’ way of life. When working in rehabilitation psychiatry, the prevailing attitude was that it is appropriate and non-discriminatory for our patients to take some of their physical complaints to general practitioners who see these presentations regularly. Sometimes (probably not often enough) we would be informed of these consultations by letter, but even then I doubt whether very many of us would copy this information into the handwritten notes. I am concerned that by only looking at secondary care case notes this survey would not have adequately detected input from primary care.

Auditing against pronouncements from the National Institute for Clinical Excellence has a certain kind of validity, but perhaps the salient question here is ‘how is the physical health of our patients recorded in its entirety?’ The new general medical services contract explicitly states that primary care is responsible for providing physical healthcare to people with serious mental illness (Lester, 2005). I am worried that in omitting mention of primary care’s contribution in any part of the discussion this paper invites us to conclude that these findings represent the full extent to which the physical health of psychiatric patients is recorded by those who are responsible for doing so. I feel this is potentially misleading.