Interview with Cyril Höschl

Why did you choose to become a doctor and why did You decide to be specialised in psychiatry?

Lacking a specific talent or motivation I always looked for the most universal study covering almost everything from math to humanities. Therefore I choose medicine, and again, among medical disciplines, psychiatry seemed mostly to correspond with this approach involving everything from biological psychiatry, ECT and pharmacology to logo-therapy, psychoanalysis and philosophy. In other words I always postponed the decision as far as possible.

What is the position of GPs in psychiatric reform in Europe, what are the main characteristics of this reform?

The main feature of the reform is a shift of mental health care (MHC) from huge mental hospitals towards community. It means among other things to establish so called mental health centres serving patients somewhere on the way between outpatient and inpatient settings and reflecting special social needs of psychiatric patients. The role of GPs becomes now more important and closer to the MHC system as GPs per definition work much closer to the natural environment of patients. GPs also become more and more involved in the psychiatric treatment process having increasing rights to prescribe antidepressants and other psychotropics. Another common area is a care for elderly.

What is the Role of GPs in 21th century from psychiatrist ´s point of view?

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What parameters might the optimal model of cooperation between GPs and psychiatrists in 21 the century have? How are we currently successful in putting it into practice?

In my eyes the crucial role of GPs in a new MHC system would be closer collaboration with MHC centres guaranteeing that somatic care for mentally ill people will not be neglected and its level will not decrease. We cannot accept demedicalization of MHC without compensation the more social and psychological approach to patients.

What is the task and what are the limits of GPs in encouraging patients to look after their mental health and wellbeing, and to feel more confident about asking for help in GP office if they need it?

This is another important role for GPs as in comparison with psychiatrists they are not as stigmatized as psychiatrists are. Therefore GPs can be invaluably helpful in overcoming barrier of non-adherence in psychiatric patients.

As a doctor, you are to some degree idealised. People sometimes expect an almost magical solution to their problems—take this pill and all will be well. What is the task of doctors to cope with this expectations and the role of placebo? Are we as doctor the remedies ourselves?

It is a crucial issue: doctors are not only evidence-based practitioners, but also healers with some flirt with science. Their power of suggestion is nicely described in Stephan Zweig’s novels Mental Healers: Mesmer, Eddy and Freud.

Do you always tell the truth to your patients?

I am trying to tell the true as much as possible. Almost always…