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Wed 6 Feb 2008 04:00 AM

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Straight talking

Dr Raymond H. Hamden counts clinical and forensic psychologist, radio show host, and NASA consultant among his job titles.

Dr Raymond H. Hamden counts clinical and forensic psychologist, radio show host, and NASA consultant among his job titles.

Medical Times hears about the status of therapy in the Middle East, the view from the psychologist's chair, and Hamden's take on the practitioners making a living at the expense of their patients.

Give me an overview of your practice's areas of interest.

Any physician confident in themselves and their methodology finds no threat in an intelligent patient asking questions for clarity.

The organisation I have here is the Human Relations Institute. We cover just about everything in psychology, from clinical, forensic, educational and organisational, health psychology and speech and language.

We have 13 members of staff, most of whom are bilingual. Our focus is to supply that cultural understanding.

As a ‘newer' aspect of medicine, do you find the cultural approach to psychology in the Middle East differs?

When I first came here 18 years ago, there was a stigma to seeing a psychologist, so I would get a lot of people from the Gulf who would say ‘I don't want to see you during working hours, but when you're closed so no-one can recognise me.'

I used to stay closed three days a week, so I could see everybody. Now we don't have that. People are more educated.

Has that education helped your radio show become more established in the community?

Well, the radio show started eight years ago, but it wasn't that I instantly came in and talked psychology, because society just wouldn't have been ready for it.

It would have been too frightening for people to be on the air talking about real situations - even within medical and psychological terms.

Have you struggled to balance cultural constraints on an open talk show?

There are still constraints, but we've come a long way. The censoring of the government has become more flexible, to recognise that we're not a ‘dirty' talk show.

We keep the content in a professional realm. We screen the calls to make sure the audience is keeping things clean and we've never, yet, had anybody abuse the show, make an issue of the problems or condemn us.

Our listeners are usually an intelligent audience.

With guests on the daytime show, more censoring is in place. We can still talk about alcohol problems, but it has to be within a medical setting.

With the younger listeners, I see problems that I didn't have to deal with until I was in my late twenties and thirties, affecting them in their teenage years.

Being of my age, it's difficult for me to keep up with the latest terminology. My co-producer fortunately is much younger than me, so she translates.

In clinical terms, do you feel psychology is adequately recognised and used in the Middle East?

There's not enough awareness among clinicians about psychology because it's not viewed at its top value. Here there is still that mentality that doesn't view therapy as a science.

Psychology is not talk therapy - you can do that in a coffee shop. The treatment protocol is very scientific.

Is psychiatry still favoured by regional physicians?

In all practices of medicine, the individual practitioner will have a preference about where to refer. Some people prefer to go to psychiatry immediately - they give the pseudo-image that the quick fix of medicine works.

But then they have a lot of repeat situations. We're seeing practitioners that are seeing too many patients and rather than treating them, they are just managing the caseload.
Updated professionals refer to psychology because the techniques that we use may take a little bit longer than that quick fix of medication, but the benefits last a lot longer.

Ninety percent of our caseload is normal people who have adjustment problems.

Then there are the 10% that have psychotic disorders who do require medication, but who still benefit from obtaining psychological intervention.

Insurance policies here typically don't cover psychology. Can you see that changing?

People repeat the same patterns over and over.

We went through the same thing in the UK until the late 80s, when insurance companies realised that including psychology as a reimbursable service saved millions of pounds for the insurance industry each year.

Unfortunately, it all comes down to economics. Whoever thinks that they can make the most money couldn't care less about what option offers the best care.

This is why we see a number of patients who are consistently referred on to certain physicians, because the referring physician is getting kickbacks.

It has nothing to do with what the patient needed in terms of treatment, it has to do with someone receiving money back for making that referral.

It loses the significance and dignity of the profession, that physicians can use their profession as a means to get rich at the expense of the consumer.

Dubai specifically has a large number of life counsellors, and similar. Do you think these professions are blurring the boundaries between psychology and counselling?

This is the reason licensure is important, because it says the government has examined credentials to rule out quackery and charlatans.

So when people are going to assume their services, they need to be sure the person has a license for not just their country of origin, but also the country in which they're practising.

And one of the clues to illegitimacy is if they are working out of a non-clinical setting. That's why the government needs to take more of a role to enlighten the consumer.

Dubaiis on the brink of introducing national clinical guidelines. Do you see psychology being included in the listings?

I believe there is already a programme being put together by the Ministry of Health. It's important mainly because the consumer is better protected when there is an overview; when government has an overview and ruling hand on practice.

Not only does that give guidelines to those who are legitimate, it stops the practice of those who are illegitimate.

One area your practice focuses on is the psychology of health, specifically the areas of communication and compliance. Any useful insights for general practitioners?

Well, there are two schools of thought on patient communication. The western school of thought is that, regardless of the patient's condition, you tell them everything.

The eastern school of thought is that, regardless of the patient's condition, you tell them nothing.

But patient education has become the number one factor in helping to ensure patient compliance. Any physician confident in themselves and their methodology finds no threat in an intelligent patient asking questions for clarity.

The more informed the patient, the more relaxed and therefore compliant the patient is. Communication leads to understanding which results in cooperation.

When the physician educates me on what I will experience and feel, what the medication is and how it will work, I'm going to comply.

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