Bibliographic record
Abstract
A move towards less custodial and more community-oriented model of care for psychiatric patients is trend in many developed countries. (1) Treatment in the least restrictive and most non-discriminatory environment is fundamental to modern psychiatric service in which patients can enjoy respect, dignity, and better quality of life. Traditionally, psychiatric outpatient clinics shoulder most of the community psychiatric care workload in Hong Kong. Linkage with general outpatient clinics, general practitioners, and private psychiatrists is limited. The psychiatrist-to-population ratio in Hong Kong is far below that of other developed societies. We have only about 200 psychiatrists, or 1 for every 33,000 people, while the ratio is about 1 to 8,000 in the United States and Canada. Through necessity, our mental health service has become highly efficient. The patient-clinician ratio in our psychiatric outpatient clinics is high compared with many western countries. Both patients and clinicians expect fast service and large turnover. Usually, only the most crucial aspects of drug compliance, relapse, and risk prevention are addressed in our busy outpatient service. Clinicians trying to manage tremendous workloads inevitably sideline the finer points, such as our patients' inner selves and their quality of life. In this issue of the Journal, Hui et al (2) report that the mean consultation time in general psychiatric outpatient clinic is only 5.6 minutes. Under-recognition of patients' needs by clinicians was observed in various domains. The consultation time correlated with the number of needs identified by clinicians. It was shown that when the 2-COM checklist was used as self-report questionnaire, communication and identification of patients' needs improved. Surprisingly, there was no correlation between consultation time and service satisfaction. The authors attributed the phenomenon to the low expectations of our patients. Their major concern was gaining information about their illness and treatment. The picture might be different if we interview the carers. Our severely mentally ill patients are usually not motivated to disclose their needs or seek help. This can be due to lack of insight, fear of stigma, and mental disabilities including negative symptoms and neurocognitive impairments. This may also explain the apparently high 'baseline' service satisfaction in the study. The authors concluded that a more comprehensive management [approach] taking into account wider range of life domains is called for. Clinicians' lack of awareness of many needs as perceived by patients draws attention to the inadequate consultation time, because of service load constraints. An increase in consultation time could improve service quality. The pertinent questions are: what causes the short consultation time and how can we allow for longer consultation time? It is obvious that our current workforce is too thinly spread and the demand for our service too great. Our current service is overwhelmed by all manner of patient needs. Amongst these are the demands of the severely mentally ill as well as those suffering from highly prevalence disorders like depression and anxiety. On top of these are demands from people with age-specific problems: the old and the young. Most of our subspecialty services are underdeveloped. The psychiatric workforce needs enhancement; but even with enhancement, the mental health service alone will not be able to cope with the huge demand. We need collaboration at all levels. There is need to work out collaborative model with the primary care doctors as well as the frontline workers. At present, referral to the specialist often means one-way ticket. In the future, we need to establish model where there will be two-way flow of referral as well as frequent communication between the two parties. Instead of trying to care for all patients with mental health problems, the mental health service should focus on the treatment of patients with complex and severe problems while supporting primary care workers and doctors to provide better service for uncomplicated and currently stable patients. …
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".