Attitudes to the use of Diagnostic Instruments Among Clinicians in Northern Norway

Rolf Wynn , Lars-Henrik Myklebust , Psychiatric Centre for Tromsø, Karlsøy and Geir Øyvind Stensland , Department of General Psychiatric Services, University Hospital of Northern Norway:

While the validity of a number of psychiatric diagnostic instruments has been established [1], few have studied the attitudes that clinicians have to their use. We were interested in how a long standing tradition of systemic work within the North Norwegian psychiatric services had influenced attitudes to diagnostic instruments [2].

A random sample of clinicians in northern Norway were invited by e-mail to answer a questionnaire on a web-site. 85 responded. 42.9% worked in district psychiatric clinics, 26% in child psychiatric services, 20.7% in psychiatric hospitals, 10.4% at colleges. 40.2% were psychologists, 36.4% were nurses or social workers, 23.4% were general practitioners. 40.2% did not ascribe to any particular theoretical orientation, 33.8% favoured a systemic approach, 26% favoured another established psychiatric approach.

28.4% had a good knowledge about diagnostic instruments, 21.6% systematically used them, and 66.2% would refer patients for such testing. Only type of work place was of importance to respondents' knowledge (multiple regression analysis, B = 0.37 (SE = 0.14), t = 2.6, p < 0.05. F (df = 3) = 3.28, p = 0.026; R ² = 0.123, adjusted R ² = 0.086). Clinicians at district psychiatric clinics most rarely had a good knowledge (8.6%), the opposite was the case with college staff (75%). There were no differences between the respondents regarding their own use of diagnostic instruments.

Only theoretical orientation was of importance with regard to referral to diagnostic testing (multiple regression analysis, B = 0.40 (SE = 0.18), t = 2.1, p < 0.05. F (df = 3) = 3.02, p < 0.05; R ² = 0.11, adjusted R ² = 0.074). Clinicians with a systemic orientation were most often interested in referring patients to testing (85%), followed by those with a biological, dynamic or cognitive orientation (73.1%), and those with an eclectic orientation (48.3%).

There was a lack of knowledge and use of diagnostic instruments, and a need to intensify training in this area, and especially so at the district psychiatric clinics. It was surprising that clinicians with a systemic orientation did not differ in self-rated use or knowledge about such testing from the others, and even that they were more willing to refer patients to testing.