Postmyocardial infarction syndrome

such problems the students were top (23% failures), house officers second (35%), and, surprisingly, nurses bottom (70%).8 Bridges and Goldberg in their paper in this week's BMJ speak of neurologists, but it is not clear whether they are referring to the consultants or to the registrars, and it will be impossible to decide who recognised or failed to recognise a psychiatric component in the patient's illness. In most hospitals, however, the most sensitive and comprehensive history is probably that taken by the registrar or his equivalent. How good it will be will depend on his experience and particular interest. An even better history would probably be obtained by the consultantprovided that he had adequate time to do this. Unfortunately, he seldom has-unlike the consultant physician or neurologist in private practice, who will set aside an hour to take a full history, examine the patient, and explain to him or her how he plans to proceed. This will be done in private, undisturbed by bleeps or other interruptions. If such an approach were possible with health service patients, and it should be, the psychiatric component of acute medical illnesses would be recognised more frequently. Expenditure on the National Health Service in Britain is less than in other developed countries. We do not have enough consultants in the acute medical and surgical specialties to allow them to devote sufficient time to each patient. Doctors in training rarely have sufficient time and many lack the experience to recognise psychiatric problems in their patients. Furthermore, facilities for a private, unhurried, and undisturbed interview are seldom available. The fact that the service is as good as it is is a tribute to the dedication of those who work in it. If the country could afford it, it could be very much better.