Psychiatrists spend much of their time in assessing desires and motives and so this often extends to their colleagues as well as their patients. In my own career I have detected three phases in their progression: the first, of enthusiasm and optimism; the second, of freewheeling or coasting; and the third, of disillusion and avoidance. These phases are not universal, but I seem to see them more frequently than I used to, and it troubles me, especially the insidious change in practice towards the sanitisation of contact with patients that accompanies career progression in so many countries. Although the work of this Journal and others advances knowledge, technology and, we trust, outcomes of mental illness, the key element of good care is personal interest, the genuine concern to get to the heart of an individual problem and get it sorted. Once we lose that, we cannot make up for it fully despite the acquisition of greater knowledge and an abundance of guidelines.
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