Ajay D Wasan1, Karin Neufeld, Geetha Jayaram. 1. Departments of Anesthesiology and Psychiatry, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA. awasan@partners.org
Abstract
OBJECTIVE: Several issues relevant to the care of Asian Indian patients remain poorly explored. Little is known about the practice patterns of psychiatrists in India, such as daily practice routines or treatment approaches, which we describe in New Delhi, India. METHODS: We focused on psychiatric practice, as perceived by Indian psychiatrists, using a sample from the USA as a comparison group. We used triangulated, qualitative methods from data gathered in India (ethnographic interviews with 16 Delhi psychiatrists, observation of treatment in India, and treatment of Indian patients) to design and validate a survey distributed to a sample of 34 psychiatrists in New Delhi and 34 in Baltimore, Maryland who treat Indian patients. RESULTS: Delhi psychiatrists saw more patients daily (24.3 vs. 11, P<0.001), and spent less time on new evaluations (33.3 vs. 69 min, P<0.001). Both groups had similar approaches to major disorders. But, Delhi psychiatrists were less likely to combine medication treatment with psychotherapy (P<0.05), and more likely to advise families to secretly administer medications in treatment refusal, such as in acute schizophrenia (P<0.001) or major depression (P<0.01). CONCLUSIONS: These differences highlight the salience of local cultural context in the practice of psychiatry and in the treatment of Indian patients. Delhi psychiatrists are overwhelmed by the epidemic levels of untreated illness, spend less time with patients, and rely more heavily on medication treatment. Delhi psychiatrists employ unique approaches to handling difficult treatment issues, such as treatment refusal, intensive involvement of the family, and recommendations to the family about suitability for marriage for a patient.
OBJECTIVE: Several issues relevant to the care of Asian Indian patients remain poorly explored. Little is known about the practice patterns of psychiatrists in India, such as daily practice routines or treatment approaches, which we describe in New Delhi, India. METHODS: We focused on psychiatric practice, as perceived by Indian psychiatrists, using a sample from the USA as a comparison group. We used triangulated, qualitative methods from data gathered in India (ethnographic interviews with 16 Delhi psychiatrists, observation of treatment in India, and treatment of Indian patients) to design and validate a survey distributed to a sample of 34 psychiatrists in New Delhi and 34 in Baltimore, Maryland who treat Indian patients. RESULTS: Delhi psychiatrists saw more patients daily (24.3 vs. 11, P<0.001), and spent less time on new evaluations (33.3 vs. 69 min, P<0.001). Both groups had similar approaches to major disorders. But, Delhi psychiatrists were less likely to combine medication treatment with psychotherapy (P<0.05), and more likely to advise families to secretly administer medications in treatment refusal, such as in acute schizophrenia (P<0.001) or major depression (P<0.01). CONCLUSIONS: These differences highlight the salience of local cultural context in the practice of psychiatry and in the treatment of Indian patients. Delhi psychiatrists are overwhelmed by the epidemic levels of untreated illness, spend less time with patients, and rely more heavily on medication treatment. Delhi psychiatrists employ unique approaches to handling difficult treatment issues, such as treatment refusal, intensive involvement of the family, and recommendations to the family about suitability for marriage for a patient.
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