Here - Surrey and Borders Partnership NHS Foundation Trust

Editorial
Expectations and You
Consider the continuing controversy
over the benefits or costs of psychiatric
diagnosis. Is it possible that the
expectation set up in the patient and
their social circle, once a diagnosis of
schizophrenia or depression is made, in
itself serves to make the implicit
prophecy entailed in such a diagnosis
come true? Because of the powerful
self-fulfilling prophecy effect of a
psychiatric diagnosis – is it possible that
users of mental health services would
benefit more from abandoning the use
of such labels?
At the heart of the education system,
psychologists contend, are ever-present
self-fulfilling prophecies. We constantly
stream children and students into better
classes or universities, then wonder why
they do better, when the power of
expectation and self-fulfilling prophecy
might be the answer, rather than any
inherent benefit of an elite education.
Our Trust
Is it possible, coming back to research in
our Trust, that the expectation of whether
or not you are going to do research
massively influences the outcome? Might
it be of benefit to the Trust and the
doctors working within it to transform
the expectation so that we ‘become
expected’, by managers, peers and
ourselves, to generate and publish much
more research than we currently do?
And doctors? Why should doctors
bother to do research? Surely doctors’
primary function is to heal the sick, and
other activities become a distraction?
Can research by used by some as a
‘noble’ from the heaving clinic? How do
eminence and academic honour
correlate with clinical acumen? Do
publication lists still appear as a magic
key in unlocking merit awards?
There are some serious obstacles that
will confront any doctor attempting
research. Firstly, finding the time,
support, advice and resources to
conduct the study. On top of a
burdensome caseload, anyone in an NHS
contract who is successful in producing
papers is frequently met with the
suspicion that they cannot be pulling
their weight clinically.
Half way through the study someone
will usually helpfully point out some
methodological consideration that
renders all your meticulous data
collection redundant, so you are faced
with the prospect of starting all over
again.
Most papers hide the key story of the
research project, which is in fact how the
investigators overcame, through adept
improvisation, often on the hoof, various
unexpected impediments tripping them
as they attempted to recruit subjects, or
measure some variable.
Once one nightmare study was over and
the data was presented at various
conferences, a researcher was asked how
he would do the study differently if he
could start all over again. His response
was that he would not do it at all.
Once you assemble the data, statistics
need to be applied. You visit statisticians
with trepidation, remembering to pack
your calculator. They take one cursory
look at the reams of numbers you had
painstakingly calculated and she bursts
out laughing because (a) you measured
the right thing but in the wrong way or
(b) you measured the right way, but
chose the wrong thing to measure or (c)
you didn’t recruit enough subjects or (d)
the measuring instrument you used isn’t
compatible with the statistical test you
hoped to apply…. And so it goes on.
Some people find that, once you have to
start using fancy statistics to illuminate
your hypothesis, the finding isn’t worth
the candle. This should reassure the
statistically naïve that genuine
discoveries are still possible for the
innumerate. Indeed in the world of
research, suspicions mount as the
statistical tests multiply.
Another wonderful revelation was the
(geeky nerdy) joy in just inspecting the
raw data, like graphing it, without
6 Surrey and Borders Online Journal www.sabp.nhs.uk/journal