How do Physicians Decide to Refer Their Patients for Psychiatric Genetic Counseling? A Qualitative Study of Physicians’ Practice

Psychiatric genetic counseling (PGC) is an emerging specialty discipline within the genetic counseling profession. A specialist PGC service was founded in 2012 in Vancouver, Canada, and though patient benefits have been demonstrated, many physicians do not regularly refer patients to the service despite awareness of its availability. We conducted a qualitative study involving semi-structured telephone interviews with Vancouver-based physicians who were aware of the PGC service to explore this phenomenon. Interviews were audio-recorded, transcribed verbatim, coded, and analysed for emergent themes. Consistent with a grounded theory approach, constant comparison was employed throughout data collection and analysis. Analyses of interviews conducted with 12 physicians revealed that referral practices were informed by perceptions about the purpose of PGC and interpretation of patient cues. Physicians perceived PGC as an information-focused intervention, and considered referral when patients explicitly expressed desire for information about recurrence risk or etiology that they felt unable to adequately address themselves. Even when physicians identified psychotherapeutic benefits of PGC, patient needs of this nature were not perceived as cues prompting referral to PGC. These data suggest that further work is necessary to position PGC in physicians’ minds as a service that could potentially benefit most individuals with psychiatric disorders and their families, and that it encompasses more than information provision. It is important to increase physicians’ awareness of the complementary role that genetic counselors can play to that of the physician in providing psychotherapeutically oriented counselling about illness etiology.     

Restrictions in working memory capacity during parachuting: a possible cause of ‘no pull’ fatalities

Working memory capacity of novice and experienced parachutists was compared under three conditions: prior to exiting the aircraft, on landing and during a control, non‐jumping day. Analysis of the operation span task revealed significant impairments in both storage and processing capacities of working memory prior to jumping. Storage capacity continued to be impaired in novice parachutists on landing whilst experienced parachutists showed full recovery. Neither group showed impairment in processing capacity on landing. Significant increases in heart rate were found for both groups in the jump and landing conditions compared to baseline but no differences existed between novices and experienced parachutists. Initial analyses support processing efficiency theory and suggest that cognitive processing may be slowing down during a jump. However, post hoc analysis of incorrect responses suggest that executive function may actually become disrupted. The results are reviewed in the context of ‘no pull’ parachuting fatalities. Copyright © 2007 John Wiley & Sons, Ltd.