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A Psychiatric 'Rashomon'

Robert L. Spitzer, MD; Andrew E. Skodol, MD; Janet B. W. Williams, DSW; Miriam Gibbon, MSW; Frederic Kass, MD

Arch Gen Psychiatry. 1982;39(11):1299-1305.

Abstract
• Psychiatric diagnoses based on data collected during routine clinical intake evaluations done by trainees are often later used in research studies and in program evaluation. It is commonly assumed that the supervisory process can effectively overcome errors that trainees make in diagnosis. We designed a study to assess the adequacy of patient-in-absentia supervision for ensuring accurate psychiatric diagnoses. In 30% of the cases there were major diagnostic disagreements between the supervised diagnoses and consensus diagnoses based on information provided by both the trainee and an experienced clinician who sat in on the trainee's initial interview. These findings have implications for clinical care, training, and research.

Author Affiliations
From the Department of Psychiatry, Columbia University College of Physicians and Surgeons; the Biometrics Research Department, New York State Psychiatric Institute (Drs Spitzer, Skodol, and Williams and Ms Gibbon); and the Vanderbilt Clinic, Columbia Presbyterian Medical Center (Dr Kass), New York.

Footnotes
Accepted for publication March 31, 1982.

Presented as the 18th Institute of Pennsylvania Hospital Award Lecture in Memory of Edward A. Strecker, MD, Philadelphia, Dec 4, 1981.

Reprint requests to Biometrics Research Department, New York State Psychiatric Institute, 722 W 168th St, New York, NY (Dr Spitzer).

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