And we're at it again -- psychologist prescribing in Oregon

[Doctor Bagel]

Hey SDN psychiatry world -- apparently Oregon is yet again going to be facing a psychologist prescribing bill. I believe this happened in 2010 and was the source of a huge discussion on this board back in that day. Details are scant, but it's real and per the rumor mill trying to pushed through quietly. I've heard limited details about education requirements for these prescribing psychologists (grr) but have heard that it will only be an option for employed rather than self employed psychologists.

As you might know, Oregon is also the state that passed legislation saying private insurance companies had the pay the same for NPs as they did for physicians so we've been on a losing stretch with these battles. I believe with the last pscyhologist prescribing battle, it came down to the governor vetoing the bill.

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[PistolPete]

Ugh. Hopefully this gets squashed.

 

[BRC]

I wonder why you think this is a bad idea? I know that there are lots of patients who can't access psychiatry care and may benefit from medication. Wouldn't psychologists be more knowledgeable about caring for mental health problems than Family Medicine doctors who already are trying to manage psych meds for patients who can't get an appointment with a psychiatrist? It seems to me this type of legislation would serve the common good.

 

[postbacpremed87]

I wonder why you think this is a bad idea? I know that there are lots of patients who can't access psychiatry care and may benefit from medication. Wouldn't psychologists be more knowledgeable about caring for mental health problems than Family Medicine doctors who already are trying to manage psych meds for patients who can't get an appointment with a psychiatrist? It seems to me this type of legislation would serve the common good.

A lot of bad things have happened with good intentions in mind. If you don't attend medical school and become a Physician, then you should not have any independence seeing patients/prescribing meds. Everything should run through the Psychiatrist. Period. This method of using a crisis to further one's agenda is a familiar one from the past. Here is a solution....create incentives for more Psychiatrists to be trained and increase reimbursements for Psych. End of story. If you want to pass the Steps and accept TOTAL responsibility without any consultation from those with more education, then you have massive cajones. See you in court, eventually.

 

[st2205]

I wonder why you think this is a bad idea? I know that there are lots of patients who can't access psychiatry care and may benefit from medication. Wouldn't psychologists be more knowledgeable about caring for mental health problems than Family Medicine doctors who already are trying to manage psych meds for patients who can't get an appointment with a psychiatrist? It seems to me this type of legislation would serve the common good.

1. Because the populations that need access to care aren't the ones who would be seeing a psychologist. Which leads to...

2. Primarily prescribing SSRIs/SNRIs of which there is no shortage of Rxs for.

3. I'd be interested in seeing a study of what proportion of people able to see a psychologist are unable to see a PCP, which then begs the question:

4. Is the plethora of PCPs prescribing antidepressants and anxiolytics actually having more benefit than cost and harm (in even very subtle psychodynamic ways)? [same question goes for NPs/PAs and even most psychiatrists]

Every piece of legislation advocating to expand the pool of "prescribers" reinforces the mistaken and iatrogenic notion that there's a drastic shortage of psychotropics on the market and that a little bit of Prozac and Xanax will help "keep people stable."

 

[FranzLO]

I wonder why you think this is a bad idea? I know that there are lots of patients who can't access psychiatry care and may benefit from medication. Wouldn't psychologists be more knowledgeable about caring for mental health problems than Family Medicine doctors who already are trying to manage psych meds for patients who can't get an appointment with a psychiatrist? It seems to me this type of legislation would serve the common good.

lol what

Yes, I would trust the physicians more when it comes to prescribing drugs.

 

[wolfvgang22]

So I consulted on a patient today regarding a suspicion of schizophrenia that was actually having delirium secondary to hyponatremia. I'm sure a crash course in psychopharmacology will be sufficient to allow a psychologist to be able to tell the difference between that and a psychotic disorder. Or not.

There are very good reasons we become Physicians first, and then train in Psychiatry. Being able to formulate differential diagnoses including medical diagnoses is one major reason.

 

[Crayola227]

Hey SDN psychiatry world -- apparently Oregon is yet again going to be facing a psychologist prescribing bill. I believe this happened in 2010 and was the source of a huge discussion on this board back in that day. Details are scant, but it's real and per the rumor mill trying to pushed through quietly. I've heard limited details about education requirements for these prescribing psychologists (grr) but have heard that it will only be an option for employed rather than self employed psychologists.

As you might know, Oregon is also the state that passed legislation saying private insurance companies had the pay the same for NPs as they did for physicians so we've been on a losing stretch with these battles. I believe with the last pscyhologist prescribing battle, it came down to the governor vetoing the bill.

The Governor is a physician, and one that is totally willing to piss off the populace to stick to what he considers good or ethical medicine.

More controversial were the death penalties he pardoned. Oregon does have the death penalty on the books, but they're pretty hippy so they don't like to use it. When they do whip it out.... they mean business. Pretty serious. So that's why it was a big deal and said a lot for his integrity as a physician, whether one agreed with him or not, that he let that guide him despite being governor. He actually did state that being a physician was why he acted as he did.

It's interesting because it sparks debates on the will of the people vs should a governor be "allowing" his ethical duties as a physician to "overrride" the will of the people.

 

[splik]

This will be an unpopular view but it is also true.

psychiatrists cant have their cake and eat it too. While I don't see the wisdom in allowing psychologists to prescribe (mainly because we dont need MORE people prescribing toxic drugs to our already largely drugged population, and these psychologists live in all the same places as psychiatrists, thus not really doing anything much to address access issues), this is a problem of psychiatry's own creation. With many psychiatrists shunning insurance, shunning medicaid/medicare, abandoning the mentally ill, having psychotherapy based practices, not offering any telepsychiatry or collaborative care services, too few medical students going into psychiatry, too few residency positions (though expanded in recent years still far less than in the 1990s before they started closing programs because of lack of interest), an ageing psychiatrist population, and many psychiatrists being paid more than they are worth, psychiatrists are at risk of becoming irrelevant and outpricing themselves out of the market place. Of course, there will always be psychiatrists because (despite so many abandoning the seriously mentally ill) psychiatrists are in the main the only group who would ever take on the challenge and liability of working with justice-involved, medically complex, substance abusing, homicidal-suicidal, psychosocial messes with terrible trauma histories. I don't see anyone clamoring to work in involuntary inner city inpatient units, staff state hospitals, or treat high risk psychotic/manic OB patients, children with murderous impulses, geriatric trainwrecks with multiple comorbidities, and so on.

I think it is unlikely this bill will pass, and if it does, like recent bills (e.g. IL), the requirements will be so narcissistically injuring to psychologists they wont avail themselves of it. Even in states like NM and LA there are less than a 100 RxPs I believe. That said, prescribing psychologists will almost certainly be a feature in the future. They will probably be some premedical requirements and certain psychology programs will offer prescribing track as part of the doctoral degree. A lot of psychology sold out to psychiatry long ago by using our diagnoses (which was a mistake on their part, they should have rejected the medical approach). The drug companies are drooling over the prospect or more people to peddle their crack on the public.

 

[splik]

The Governor is a physician, and one that is totally willing to piss off the populace to stick to what he considers good or ethical medicine..

hes not governor anymore, was forced to resign due to some nepotism scandal and other problems with his wife. current governor is a lawyer

 

[Doctor Bagel]

hes not governor anymore, was forced to resign due to some nepotism scandal and other problems with his wife. current governor is a lawyer

And making statements about closing the new state hospital in her budget which makes me think she's not really in the know with the mental health system.

 

[Merovinge]

psychiatrists cant have their cake and eat it too. While I don't see the wisdom in allowing psychologists to prescribe (mainly because we dont need MORE people prescribing toxic drugs to our already largely drugged population, and these psychologists live in all the same places as psychiatrists, thus not really doing anything much to address access issues), this is a problem of psychiatry's own creation. With many psychiatrists shunning insurance, shunning medicaid/medicare, abandoning the mentally ill, having psychotherapy based practices, not offering any telepsychiatry or collaborative care services, too few medical students going into psychiatry, too few residency positions (though expanded in recent years still far less than in the 1990s before they started closing programs because of lack of interest), an ageing psychiatrist population, and many psychiatrists being paid more than they are worth, psychiatrists are at risk of becoming irrelevant and outpricing themselves out of the market place. Of course, there will always be psychiatrists because (despite so many abandoning the seriously mentally ill) psychiatrists are in the main the only group who would ever take on the challenge and liability of working with justice-involved, medically complex, substance abusing, homicidal-suicidal, psychosocial messes with terrible trauma histories. I don't see anyone clamoring to work in involuntary inner city inpatient units, staff state hospitals, or treat high risk psychotic/manic OB patients, children with murderous impulses, geriatric trainwrecks with multiple comorbidities, and so on.

This is not at all an issue unique to psychiatists, it's an issue with being a physician. More and more physicians are running concierge medicine, some are entering fields that almost no insurance pays for (elements of derm, plastics, vein surgery, fertility etc.). There are too few residency positions in basically every field related to how they are funded (and dont even start on NSGY which has kept their numbers so artificially low to pump egos and paychecks). Why every pay for a PCP when you can have a PA/NP? Is family medicine just an irrelevant specialty that should be laid to rest now? DOCTORS not just psychiatrists have been pushed so hard by profit driven insurance companies, hospitals, and governments that people are taking a stand. Our reimbursement is done so poorly where no or little extra is paid for a patient that is 10x sicker but that is certainly not because of doctors.

Finally some of us (me) are clamoring to work with inner city, underserved, high rate of sub abuse, high rate of mania/psychosis, highly suicidial and homicidial "trainwrecks". I happen to be super lucky to have gotten a job that lets me do so and pays me fairly but those positions are scare. I know from my training many of my co-residents would have done the same if the payment was there for it.

 

[WisNeuro]

So I consulted on a patient today regarding a suspicion of schizophrenia that was actually having delirium secondary to hyponatremia. I'm sure a crash course in psychopharmacology will be sufficient to allow a psychologist to be able to tell the difference between that and a psychotic disorder. Or not.

There are very good reasons we become Physicians first, and then train in Psychiatry. Being able to formulate differential diagnoses including medical diagnoses is one major reason.

Lol, I've actually been consulted a handful of times to evaluate inpatients where the residents thought something was going on, usually schizophrenia or WKS, and it was just plain old delirium. I do this better than MDs already.

 

[st2205]

Lol, I've actually been consulted a handful of times to evaluate inpatients where the residents thought something was going on, usually schizophrenia or WKS, and it was just plain old delirium. I do this better than MDs already.

Better than psychiatrists or non-psychiatrists? Non-psychiatrist physicians are awful at clinically differentiating delirium from a host of other psychiatric problems. That's a reflection of the poor state of psychiatric education in the medical curriculum. We get people to memorize the nonsense of ASD vs PTSD or brief psychotic disorder vs schizophreniform vs schizophrenia that everyone misses the boat on what psychosis is (rather than trying to parse out different etiologies of psychosis) and how it differentiates clinically from delirium.

Regarding what was quoted, I'd argue that the scenario would be unlikely to happen simply because that's not the type of setting the prescribing psychologist would be exposed to. We use all these SMI populations with limited/poor access to psychiatric care as the rationale for expanding "prescribers" when in reality none of them are going to be managing acute or chronic psychosis or mania, but will be picking off a population of relatively easy cases that are seeing their PCP currently.

 

[WisNeuro]

Better than psychiatrists or non-psychiatrists? Non-psychiatrist physicians are awful at clinically differentiating delirium from a host of other psychiatric problems. That's a reflection of the poor state of psychiatric education in the medical curriculum. We get people to memorize the nonsense of ASD vs PTSD or brief psychotic disorder vs schizophreniform vs schizophrenia that everyone misses the boat on what psychosis is (rather than trying to parse out different etiologies of psychosis) and how it differentiates clinically from delirium.

Regarding what was quoted, I'd argue that the scenario would be unlikely to happen simply because that's not the type of setting the prescribing psychologist would be exposed to. We use all these SMI populations with limited/poor access to psychiatric care as the rationale for expanding "prescribers" when in reality none of them are going to be managing acute or chronic psychosis or mania, but will be picking off a population of relatively easy cases that are seeing their PCP currently.

Non-psychiatrists, generally. With my psychiatrists, I usually have to explain how opiates and anticholinergics in the elderly can be....not great. My comment was more on the notion of that particular example not a great one in arguing against RxP. But yes, I agree about things on the psychotic spectrum, we get a fair number of patients where things have been mis-characterized to a great deal over the years, with many competing, exclusive diagnoses in the chart.

 

[SmallBird]

Non-psychiatrists, generally. With my psychiatrists, I usually have to explain how opiates and anticholinergics in the elderly can be....not great. My comment was more on the notion of that particular example not a great one in arguing against RxP. But yes, I agree about things on the psychotic spectrum, we get a fair number of patients where things have been mis-characterized to a great deal over the years, with many competing, exclusive diagnoses in the chart.

You are pointing out the incredible value of neuropsychological evaluation for some patients. Just this week I saw a patient with a highly complex mix of cognitive impairments and behavioral symptoms. Finding them a neuropsychologist in the next 6 months is a challenge. I can find plenty of people that would throw neuroleptics at her. Psychologists already add value and if prescribing rights will take them away from these critical tasks they will be bad for patient care. This seems to be -more important argument then focusing on the aspects of our job which draw prominently on our general medical education.

 

[Doctor Bagel]

Non-psychiatrists, generally. With my psychiatrists, I usually have to explain how opiates and anticholinergics in the elderly can be....not great. My comment was more on the notion of that particular example not a great one in arguing against RxP. But yes, I agree about things on the psychotic spectrum, we get a fair number of patients where things have been mis-characterized to a great deal over the years, with many competing, exclusive diagnoses in the chart.

I find that amazing that you would have to explain that to a psychiatrist. That was kinda of psych 101 where I trained (even in medical school).

 

[Doctor Bagel]

You are pointing out the incredible value of neuropsychological evaluation for some patients. Just this week I saw a patient with a highly complex mix of cognitive impairments and behavioral symptoms. Finding them a neuropsychologist in the next 6 months is a challenge. I can find plenty of people that would throw neuroleptics at her. Psychologists already add value and if prescribing rights will take them away from these critical tasks they will be bad for patient care. This seems to be -more important argument then focusing on the aspects of our job which draw prominently on our general medical education.

The curious thing is that I'm not sure many psychologists want to prescribe. It doesn't make sense to me why you would become a psychologist and then want a primary focus of your work to be prescribing medication. Doesn't one become a psychologist because they want to do psychotherapy or because they want to do neuropsych testing etc?

 

[WisNeuro]

I find that amazing that you would have to explain that to a psychiatrist. That was kinda of psych 101 where I trained (even in medical school).

I am astounded too, at times. But, I'd say once or twice a month I have to outline the anticholinergic burden, in addition to other possible med effects, as to why we can't be sure if the cognitive problems are a dementia of some sort, or the meds. "You mean having them on Oxybutynin, hydroxyzine, and oxycodone could be causing their attention and memory problems?"

 

[WisNeuro]

The curious thing is that I'm not sure many psychologists want to prescribe. It doesn't make sense to me why you would become a psychologist and then want a primary focus of your work to be prescribing medication. Doesn't one become a psychologist because they want to do psychotherapy or because they want to do neuropsych testing etc?

Even with a hefty pay bump, I wouldn't do it. The only utility I would see in having Rx rights in my practice, would be to get some of my patients tapered off of obviously inappropriate medications.

 

[erg923]

The curious thing is that I'm not sure many psychologists want to prescribe. It doesn't make sense to me why you would become a psychologist and then want a primary focus of your work to be prescribing medication. Doesn't one become a psychologist because they want to do psychotherapy or because they want to do neuropsych testing etc?

I went into clinical psych to become psychological scientist/researcher, but became primarily a clinician and mental health program director. Therapy is nice, testing is boring, program coordinating/development and student education/training is "where its at."

I have no interest in throwing more garbage at an already vulnerable population.

 

[SmallBird]

I am astounded too, at times. But, I'd say once or twice a month I have to outline the anticholinergic burden, in addition to other possible med effects, as to why we can't be sure if the cognitive problems are a dementia of some sort, or the meds. "You mean having them on Oxybutynin, hydroxyzine, and oxycodone could be causing their attention and memory problems?"

I find that amazing that you would have to explain that to a psychiatrist. That was kinda of psych 101 where I trained (even in medical school).

It's an anecdote. I don't think anybody feels we carry the burden of proof for showing that we are the best trained members of the mental health team to diagnose and manage medical causes of psychiatric illness. If this poster has been helpful in this way that's great for them but it's not an argument.

 

[st2205]

Non-psychiatrists, generally. With my psychiatrists, I usually have to explain how opiates and anticholinergics in the elderly can be....not great. My comment was more on the notion of that particular example not a great one in arguing against RxP. But yes, I agree about things on the psychotic spectrum, we get a fair number of patients where things have been mis-characterized to a great deal over the years, with many competing, exclusive diagnoses in the chart.

You're working along side some incredibly incompetent psychiatrists.

 

[WisNeuro]

You're working along side some incredibly incompetent psychiatrists.

In some select cases, I tend to agree. Unfortunately, this is not isolated to my current site. It's been an issue in the past as well at other sites.

 

[thoffen]

I generally don't think it's a good idea for psychologists to prescribe, but there's plenty of ambivalence in there too.

More importantly, psychiatrists aren't realistically being threatened by this stuff being passed.

 

[Doctor Bagel]

I generally don't think it's a good idea for psychologists to prescribe, but there's plenty of ambivalence in there too.

More importantly, psychiatrists aren't realistically being threatened by this stuff being passed.

Probably mostly true. In my state, we've already got NPs who function independently and are hired to do identical things as psychiatrists. I think our training does count for something, but I don't accountants and hospital administrators are going to continue to see that. The threat of psychologist prescribing probably won't play out for many years, but it does signify further erosion into our jobs and our role.

 

[st2205]

Probably mostly true. In my state, we've already got NPs who function independently and are hired to do identical things as psychiatrists. I think our training does count for something, but I don't accountants and hospital administrators are going to continue to see that. The threat of psychologist prescribing probably won't play out for many years, but it does signify another erosion of our jobs and our role.

Or, what I feel more importantly, is more "evidence" validating the "chemical imbalance" theory, the externalization, rationalization and avoidance of insight. One would think, as advertised, psychologists may be more attuned to these conflicts and appreciate the long-term damage inflicted on society as a result. On the other hand the perceived increase in job stability and dollar signs, with probably a fair amount of chip on the shoulder, has a large sway, too.

 

[Wilf]

All doctors should be very concerned about psychologist prescriber legislation because unlike with nurses, PAs, CRNAs, or optometrists, psychologists are not medically trained. The aforementioned professions should have supervision by physicians. I do not agree with splik that psychiatrists have done this to themselves. Safety should be the primary concern and high standards need to remain for people who prescribe medications, which can be dangerous, to patients.

 

[Shikima]

Or, what I feel more importantly, is more "evidence" validating the "chemical imbalance" theory, the externalization, rationalization and avoidance of insight. One would think, as advertised, psychologists may be more attuned to these conflicts and appreciate the long-term damage inflicted on society as a result. On the other hand the perceived increase in job stability and dollar signs, with probably a fair amount of chip on the shoulder, has a large sway, too.

It's my Bipolar acting up again...

 

[smalltownpsych]

I am so grateful that I don't have prescription privileges and I don't think I ever will want them. Although, extra money could be hard to say no to. The truth is that the longer I practice, the more I see the negative psychological effects of our cultures faith in medication as a panacea for psychic distress.

 

[Shikima]

I am so grateful that I don't have prescription privileges and I don't think I ever will want them. Although, extra money could be hard to say no to. The truth is that the longer I practice, the more I see the negative psychological effects of our cultures faith in medication as a panacea for psychic distress.

Any good articles on this subject?

 

[erg923]

I wonder why you think this is a bad idea? I know that there are lots of patients who can't access psychiatry care and may benefit from medication. Wouldn't psychologists be more knowledgeable about caring for mental health problems than Family Medicine doctors who already are trying to manage psych meds for patients who can't get an appointment with a psychiatrist? It seems to me this type of legislation would serve the common good.

The vast majority of people with emotional problems do not need "psychiatric care." They need counseling, motivational enhancement, life skills, more money, healthier diets, more exercise, less toxic relationships, or all of the above. This self serving notion that more people need to be on psychiatric medication in this country is simply not true.

 

[PsyDr]

So I consulted on a patient today regarding a suspicion of schizophrenia that was actually having delirium secondary to hyponatremia. I'm sure a crash course in psychopharmacology will be sufficient to allow a psychologist to be able to tell the difference between that and a psychotic disorder. Or not.

There are very good reasons we become Physicians first, and then train in Psychiatry. Being able to formulate differential diagnoses including medical diagnoses is one major reason.

I received a neuropsych consult yesterday with a referral question of "Dementia?". Pt was a young woman, long standing Bipolar I, with new onset rapid confusion, new onset movement difficulties, and an active UTI. Long story short, after begging for an order for labs: Li toxicity.

 

[smalltownpsych]

Any good articles on this subject?

Most of the stuff I read about this is theoretical and anecdotal. I was trying to find research to support the theory and types of treatment that we provided at a therapeutic boarding school and found little to nothing out there. Just bits and pieces to possibly support aspects of what we did. Nevertheless, our own non-scientific outcome research indicated that we had incredibly obvious overall positive improvements and this was correlated with approximately 80% of our adolescents being decreased or removed altogether from medications. Meanwhile, there is tons of literature to support the use of medications, but the long term efficacy and correspondence with improvements in function aren't really out there either.

 

[Merovinge]

I received a neuropsych consult yesterday with a referral question of "Dementia?". Pt was a young woman, long standing Bipolar I, with new onset rapid confusion, new onset movement difficulties, and an active UTI. Long story short, after begging for an order for labs: Li toxicity.

Okay, and? I got a consult from a patient seeing a psychologist for long-term therapy (approx 2 years) who clearly was suffering from schizophrenia and they had been tip-toeing over this young pt's complete meltdown letting months go by until it reached an irrefutable breaking point. Anecdote game is silly in this situation.

Is your point that psychologists have the same training in medical diagnosis and disorders and should be doing the same work as psychiatrists? If you became acutely encephalopathic with behavioral disturbances tomorrow do you want to be seen by a psychologist or a psychiatrist?

 

[WisNeuro]

Okay, and? I got a consult from a patient seeing a psychologist for long-term therapy (approx 2 years) who clearly was suffering from schizophrenia and they had been tip-toeing over this young pt's complete meltdown letting months go by until it reached an irrefutable breaking point. Anecdote game is silly in this situation.

Is your point that psychologists have the same training in medical diagnosis and disorders and should be doing the same work as psychiatrists? If you became acutely encephalopathic with behavioral disturbances tomorrow do you want to be seen by a psychologist or a psychiatrist?

I think I'd rather see a Neurologist.

 

[Merovinge]

I think I'd rather see a Neurologist.

Which is great when it presents with obviously neurologic findings, but I'm sure you are aware there are "psych" presentations to encephalitis.

 

[WisNeuro]

Which is great when it presents with obviously neurologic findings, but I'm sure you are aware there are "psych" presentations to encephalitis.

In that case, I'd rather see a neuropsychologist first if I had to choose, who would then send me to a Neurologist ASAP. Really besides the point, they shouldn't be seeing either a psychiatrist or psychologist for this acute issue.

 

[PsyDr]

Okay, and? I got a consult from a patient seeing a psychologist for long-term therapy (approx 2 years) who clearly was suffering from schizophrenia and they had been tip-toeing over this young pt's complete meltdown letting months go by until it reached an irrefutable breaking point. Anecdote game is silly in this situation.

Is your point that psychologists have the same training in medical diagnosis and disorders and should be doing the same work as psychiatrists? If you became acutely encephalopathic with behavioral disturbances tomorrow do you want to be seen by a psychologist or a psychiatrist?

You do see the irony in presenting anecdotal evidence to support a position and then immediately deriding anecdotal evidence, right?

 

[Merovinge]

In that case, I'd rather see a neuropsychologist first if I had to choose, who would then send me to a Neurologist ASAP. Really besides the point, they shouldn't be seeing either a psychiatrist or psychologist for this acute issue.

See this response is exactly what I am talking about. When you come in acutely manic seeing vivid hallucinations hospitals are not going to send you to a neuropsychologist. If you happen to have a huge neurology department and the ED is particularly savvy they may recognize your presentation is not classic mania and there is an off-chance you see a neurologist but the overwhelming majority of the time you are going to be seen by a psychiatrist. And you should be, we get consulted by neurology for NMDA encephalopathy.

 

[Merovinge]

You do see the irony in presenting anecdotal evidence to support a position and then immediately deriding anecdotal evidence, right?

You do see the point is that anyone can write down a N=1 case and it provides absolutely nothing to the discussion. You do see that I demonstrating that point, right?

 

[Beezlebub]

I wonder why you think this is a bad idea? I know that there are lots of patients who can't access psychiatry care and may benefit from medication. Wouldn't psychologists be more knowledgeable about caring for mental health problems than Family Medicine doctors who already are trying to manage psych meds for patients who can't get an appointment with a psychiatrist? It seems to me this type of legislation would serve the common good.

wtf do you even have to ask this? someone from SDN please confirm this guy. B/c psychologists do not have the proper training to handle medications, consequently this places patients at great risk for harm and possibly death. Ridiculous.

 

[WisNeuro]

Given the differentials and methods to diagnose the different encephalopathies, yeah, still would much rather see a neurologist.

 

[WisNeuro]

wtf do you even have to ask this? someone from SDN please confirm this guy. B/c psychologists do not have the proper training to handle medications, consequently this places patients at great risk for harm and possibly death. Ridiculous.

I think you do have to ask this. This has been happening in some states for over a decade. There is data out there if you'd like to support your claim.

 

[MLT2MT2DO]

In that case, I'd rather see a neuropsychologist first if I had to choose, who would then send me to a Neurologist ASAP. Really besides the point, they shouldn't be seeing either a psychiatrist or psychologist for this acute issue.

You realize a Neurologist will then consult a psychiatrist to assist with the behavioral complications, right? Neurology is more than happy to take care of the inciting incident causing encephalopathy, but behavior their not a fan of treating.

Of course if you think sending someone with inappropriate mastubatory behavior with agitation to do some neuropsychiatric testing is the better course....have fun.


Sent from my SM-G900V using SDN mobile

 

[Beezlebub]

I think you do have to ask this. This has been happening in some states for over a decade. There is data out there if you'd like to support your claim.

this is a dangerous road to tread.

 

[WisNeuro]

You realize a Neurologist will then consult a psychiatrist to assist with the behavioral complications, right?

Of course if you think sending someone with inappropriate mastubatory behavior with agitation to do some neuropsychiatric testing is the better course....have fun.

Sure, but you'd want to rule out other, more serious conditions first. Also, this strawman is still besides the point.

 

[WisNeuro]

this is a dangerous road to tread.

The road has already been paved.

 

[Merovinge]

Sure, but you'd want to rule out other, more serious conditions first. Also, this strawman is still besides the point.

Besides the point on what? Completely different training for completely different jobs not being equivalent?

 

[WisNeuro]

Besides the point on what? Completely different training for completely different jobs not being equivalent?

Yes, that was never the case.