Psychiatric Formulation Demystified – The Sherlock Holmes Way

sherlock holmesWilliam Osler said, “Ask not what disease the person has but rather what person the disease has?”.
This powerful single statement forms the basis of a psychiatric formulation which emphasises the importance of the patient history rather than the label. The article is written to equip you with the right mental model to approach the psychiatric formulation. There are two formulation examples at the end. It is not only applicable for the RANZCP OCI/M-OCI exam but anyone practicing mental health. Click here to read the article.

Click here to read other articles on formulation and management.


This article is written by Dr Sanil Rege. Sanil is a Consultant Psychiatrist in private practice on the Mornington Peninsula and co-founder of He is pursuing an MBA at the Melbourne Business School.  You can follow him on Google+

5 Responses to "Psychiatric Formulation Demystified – The Sherlock Holmes Way"

  1. Suniti Pande says:

    Thank you for this article. I am a practice for the last 25 years and want to compliment you on the concise and clear writing. I am sure it will help many new Psychiatrists.

  2. Dr. Shashvat Shere says:

    Very good article. The most practical approach to the patients & their management. My teacher in Psychiatry had said there are 3 important questions you need to ask yourself if you want to understand your patient: 1. Why is this person suffering from mental illness? ( And not other persons around )
    2. Why is this person suffering at this time? ( Why not before or later )
    3. Why is this person suffering from only these type of symptoms? (And not other symptoms )
    Solving all these queries in each case makes every case very interesting and gives very useful clues for the management.
    Makes psychiatry interesting, no chance of getting bored with ‘routine’ work.
    Dr. Shashvat Shere, Cons. Psychiatrist, Ratnagiri, India.

  3. Sanil says:

    Dear Shashvat,
    Wise words indeed, I agree that it does make clinical practice interesting as one sees a wide range of variables that affect patients .
    I added a fourth question in this short blog piece written some time back.

  4. Great article! It is imperative that the zebras are identified as quickly as possible and are not mislabeled. If these techniques you discussed were used more often, then surely the average 7 year diagnostic delay for rare illness could be minimized.

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