Dr Albino Oliveira-Maia studied Medicine at the University of Porto and obtained his PhD at Duke University Medical Center in the USA. He is currently a resident in psychiatry and mental health at Centro Hospitalar de Lisboa Ocidental, a clinical research fellow at the Champalimaud Neuroscience Programme and directs the Neuropsychiatry unit. His research interests include studying gustatory and food reward circuits, as well as satiety states and brain mechanisms of food intake control.
What are the kinds of treatment methodologies available to a psychiatrist in Portugal and how is this methodological diversity comparable with what is practiced in other developed countries?
The treatment options available for psychiatric patients are not that different from what is available in other countries. We have psychotherapeutic options, pharmacological treatment, psychosocial and psycoeducational approaches…In the area of neurostimulation we are somewhat behind the US and some other European countries. Vagus nerve stimulation (electrical stimulation of the nerves that convey sensory information about the body’s organs to the central nervous system, and efferent information from the brain back to the viscera – stimulating the left vagus nerve is used as a treatment of epilepsy and severe depression), is available in a few centers, as is transcranial magnetic stimulation (electromagnetic stimulation of the brain, applied in some types of major depression). However, there was only a small trial for deep brain stimulation in Coimbra a few years back, and, currently, I believe that there is no center offering treatment to psychiatric patients.
Getting an appointment with a psychiatrist in Portugal seems to take a long time. What is your time estimate given your experience?
I guess it does take somewhat long, particularly in the public health system. In fact, according to 2010 data recently published by the National Observatory of Health Systems, the average waiting time varies from a minimum of 51.5 days in Alentejo to a maximum of 178.5 days in the Algarve. This is an improvement from prior data, but still insufficient. There are, however, psychiatrists at the emergency services of many public hospitals across the country, such that when a patient is in need of urgent care, that option is always available. I have no experience with the private sector, but my impression is that they have a much shorter waiting time.
There is a feeling that there is a general lack of psychiatrists in all countries and that Portugal is not an exception. Can this account for the waiting time for an appointment?
Looking at 2007 OECD (Organization for Economic Co-operation and Development) statistics, we have 10 psychiatrists per 100,000 people, which is far from the numbers in Switzerland, France and Scandinavian countries, with as much as 42 psychiatrists per 100,000 people. However, the statistics also show that we are among the countries where general practitioners are most involved in mental health care. In fact, adequate training of general practitioners in the care of the more prevalent and less severe mental health disorders is probably the most effective way to get the best possible care to the largest number of patients. Irrespective of that, a low number of psychiatrists will definitely contribute to longer waiting times for an appointment. I believe it also creates a higher demand for clinical care and makes it harder for physicians to do research.
Why do you think psychiatry is such an unattractive medical specialty from the medical student point of view? One would guess that if it was more attractive, there would be more psychiatrists.
Actually, at least in Portugal and many other European countries, the limit on the number of psychiatrists is imposed by the government, which defines the number of vacancies for training in each medical specialty. Also, while psychiatry is not the first choice for most physicians, I don’t really think that it is that unattractive (but maybe that is why I am training as a psychiatrist…). In any case, going back to your original question, I guess the reasons why many students do not choose to be psychiatrists are: 1) there is a lot of stigma associated with psychiatric diseases, psychiatric patients and psychiatrists, even among other health professionals; 2) psychiatric diagnosis is based mostly on subjective evaluation, rather than objective evidence from sophisticated diagnostic tools; 3) psychiatrists are not among the better paid physicians.
Why do you think medical doctors look at science as a sort of ‘optional career path’?
We would have a real problem if all physicians were dedicated to science. This is not and cannot be the main focus of medical doctors, who are trained to be clinicians and are necessary to society as clinicians. So, to some degree, science is an optional path – it is pretty tough to co-ordinate clinical duties with scientific activity and it will only work out if one is passionate about it. However, I also believe physicians’ medical education should involve stronger scientific training, mainly because they will become better physicians, even if science will not be a career option for them. Furthermore, I also think that, in Portugal, the option for a clinical and scientific career should be more protected, to allow for more enthusiasts to take this path. Hopefully, institutions such as the Champalimaud Foundation, with a strong translational philosophy, will contribute for this to happen.
Your last publication, which demonstrates that reward signals are also sent to the brain at the time when highly caloric food reaches blood circulation, must have brought you into close contact with the Portuguese media. We therefore guess that you felt the difficulties of conveying a scientific message to the media, namely the concept that the research you have done cannot be directly applied to human health right now. Why do you think it is so hard to pass that kind of message to the media?
The media is specialized in the broadcast of important information that has an immediate and understandable effect on people’s lives. When a scientific message is being transmitted through the media, particularly in the case of biomedical research, there is a clear tendency to try to extract that kind of information. I think that, as scientists, we have a double responsibility when trying to explain our work. First of all, we should clarify our objectives and, if human health is a part of it, that should be made clear – those who suffer from that disease have the right to know. However, we should also be cautious not to create false expectations, and that is very tricky when one is interacting with the press.
Bruno Afonso is a former PhD student from the Gulbenkian Institute.