Psychiatric Medical Consensus: Importance Over Patient Opinion

Medical consensus in psychiatry is critical. Many people do have many opinions, of course, but understanding psychiatric medical consensus is what makes all the difference. If you have 1000 psychiatrists in a room, after all, you can be guaranteed someone is going to disagree on any subject, but who do you believe, the 999 or the one? And is a medical consensus in psychiatry worth more than the opinion of psychiatric patients?

What Is Medical Consensus in Psychiatry?

According to the Medical Dictionary,¹ a "consensus statement" is:

A comprehensive summary of the opinions of a panel of experts about a particular scientific, medical, nursing, or administrative issue. Its purpose is to provide guidance to health care professionals esp. [especially] on controversial or poorly understood aspects of care.   

So a psychiatric medical consensus, then, is a summary of opinions about a topic relating to psychiatry. As the above definition says, this is typically issued for controversial or poorly-understood subjects. A medical consensus may lead to a formal position or policy for an organization and typically drives practice guidelines.

For example, the American Psychiatric Association (APA) published the following in 2015 as their official position on electroconvulsive therapy (ECT):²

Electroconvulsive Therapy (ECT) is a safe and effective evidence-based medical treatment. ECT is endorsed by the APA when administered by properly qualified psychiatrists for appropriately selected patients.

This is the conclusion all the available evidence has led to, even though ECT may be considered controversial by some.

Why a Psychiatric Medical Consensus Matters

Often, doctors look to a medical consensus for information on how to treat someone. That is because doctors don't have the time to read all the research on every topic. It's impossible to keep up with every study in every journal. Moreover, all doctors, even specialists like psychiatrists, must treat things in which they have not analyzed all the data. (The more refined the subject area of a specialist, however, the most likely they know all the literature on it.) That's why experts in a particular area of medicine, those who do understand the technical details behind all the studies on a given subject, are the ones who shape the medical consensus. Consensus indicates a broad acceptance.

For example, for the above, the APA Assemply plus their Board of Trustees had to sign off on the written official policy.

Don't Patient Opinions Matter in a Medical Consensus in Psychiatry?

Whether or not a psychiatric medical consensus matters more than the opinions of patients depends on how you look at it. Any patient's opinion matters to that patient and, hopefully, his or her provider. However, does a patient opinion matter to the medical consensus in a field like psychiatry? Probably not.

For example, there are special interest groups out there who will tell you that ECT is evil and should be outlawed. There are also people who have had bad experiences with ECT. But as I said, in any room of 1000 people (like patients), some are going to disagree (and in the case of patients, most aren't going to understand the scientific literature).

And if you research ECT on your own, you may be very scared by the bad experienced and/or swayed by special interest groups. These things may form your opinion on ECT.

Why Medical Consensuses in Psychiatry Matter More Than Your Opinion

And this is where the importance of a psychiatric medical consensus comes in. During your research, you may have found scary stories, but those stories are by one person on the Internet, and you don't even know if they are real. And if there is a group that collects these stories, they may look overwhelming. Moreover, you may have found a study that appeared to support a scary position. But the psychiatric medical consensus on ECT should be weighed more heavily than any of that because actual experts drove it. Actual experts who really run studies and treat patients every day and understand neuroscience drove that consensus. That makes it infinitely more meaningful than random anecdotes on the Internet. It also makes it more meaningful than any one, single study of which you don't understand the mechanics.

I get asked all the time what my opinion is of ECT, and I get asked whether an individual should get it. My answer is always the same: Electroconvulsive therapy can be a very effective treatment for some conditions (like treatment-resistant depression) and is a good choice for some people and not others. The only way you will know which one you are is by talking to your psychiatrist.

I can confidently say that because my opinions, too, are evidence- and consensus-driven. I know that some people don't agree with that, and that's okay. Psychiatric medical consensus is more important than those patient's opinions. And that's okay.

(Note that I am not saying you have to do something just because there is a medical consensus in psychiatry. As I mentioned, each person is an individual, meaning that some things will be right for you while others won't. That's okay, too.)

Source

1. Medical Dictionary, "consensus statement." Accessed August 1, 2020.
2. American Psychiatric Association, "Position Statement on Electroconvulsive Therapy (ECT)." July 2015.