Monitoring treatment with aminoglycoside antibiotics.

EDITOR,-Renewed interest in the activities and professional training of counsellors in general practice is welcome.'2In the 1990s there will be a concerted move by professional bodies such as the British Association for Counselling and the British Psychological Society to regulate counselling and ensure that those who practise are both competent and qualified to do so.Contrary to some popular wisdom, bad counselling can be damaging to patients.The question of who counsels patients in medical settings needs to be addressed.There is some difference between being a counsellor and having counselling skills.Almost all health care professionals with primary training in medicine, nursing, physiotherapy, or other allied professions counsel people during their work: if the broadest definition of the term is used an episode of counselling occurs in every medical consultation.Health care professionals constantly give patients information, clarify treatment options, and help people to adjust to new, and sometimes unwelcome, circumstances.Specialist counsellors, on the other hand, have usually had advanced training in counselling, psychotherapy, or family therapy, and some may be professionally trained in other disciplines such as medicine, clinical psychology, social work, or nursing.Although specialist training is not a requirement to practise as a counsellor, a professional may occasionally refer a patient to a specialist counsellor in the same way that a doctor may refer medical problems to a specialist colleague.3Clinical and counselling psychologists do not deal only with mental illness.Our training (at MSc level) emphasises the need for counselling skills for people with many complex medical problems, including HIV infection, management of diabetes, infertility, problems after disasters, pain control after surgery, and neurological problems.In addition, psychologists conduct collaborative research with their colleagues in general practice, provide health education to patients, and conduct psychosocial assessments and may also provide a consultation and liaison service.Though there may currently be an undersupply of qualified and accredited counsellors, this should not deter doctors from referring patients to them when resources permit.