"Prescribing" (suggesting?) marijuana...

[Cytarabine]

Yes. I think they will. They'll also be better trained to know how to weed out depression and bipolar issues. They'll be better equipped to test for ADHD rather than acquiescing to moms just doctor shopping because their kid won't sit still in church. You pay for that whole hour on that one issue instead of "I need medication for blood pressure, diabetes, asthma, and pre-screened for the sleep study, and oh, by the way, I'm depressed, give me drugs" all within a 30 minute window, then schedule a follow up in a 3 months because they're all booked up until then.

Yeah, I think a psychiatrist will and should do better.

Good thing we have a surplus of psychiatrists with empty schedules to whom we can send those patients with psych issues managed by PCPs. The reality of the matter isn't A vs B. It's A now vs B maybe months down the line. Patients would probably be better treated too with formal psychometric testing by psychologists to establish diagnosis prior to treatment. Just not feasible for every / most patient(s), and maybe not a judicious use of resources even if the access and payment was there

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[473912]

Indeed. They went to med school to learn about pharmacology, and they chose the broadest of all medical specialties because, presumably, they like caring for the whole person.

I cannot handle all the psych in a 5 panel Primary care clinic. If I told my physicians to "stay in their lane..ILL HANDLE ALL THIS PSYCH STUFF" they'd look at me like I was idiot and say, "yea...good luck wit that."

Why not? Doctors don't complain about "handling all the medical stuff" then outsource their work to people not specifically trained in medicine. Sounds like you should complaining to the system you work in, not to me. It's thoughts like this... that we're just some subset of doctor instead of our own profession uniquely qualified that keeps psychology second rate in everyone's eyes.

They care about the whole person... nnnn's MEDICAL needs. Emphasis on medical.

 

[473912]

Good thing we have a surplus of psychiatrists with empty schedules to whom we can send those patients with psych issues managed by PCPs. The reality of the matter isn't A vs B. It's A now vs B maybe months down the line. Patients would probably be better treated too with formal psychometric testing by psychologists to establish diagnosis prior to treatment. Just not feasible for every / most patient(s)

Sounds like maybe letting psychologists prescribe is a good idea, then. I'd rather a psychologist prescribing than an NP or a doc that deals with obesity symptoms 85% of the time.

 

[Cytarabine]

Why not? Doctors don't complain about "handling all the medical stuff" then outsource their work to people not specifically trained in medicine. Sounds like you should complaining to the system you work in, not to me. It's thoughts like this... that we're just some subset of doctor instead of our own profession uniquely qualified that keeps psychology second rate in everyone's eyes.

They care about the whole person... nnnn's MEDICAL needs. Emphasis on medical.

PCP's don't complain about handling "all the medical stuff" because they don't do that. No one is capable of that. They handle what they feel they're capable of handling and refer out for additional services as they feel necessary. Bread and butter CHF, easily managed. CHF and chronic renal failure that's had repeat hospitalizations for acute decompensations... cardiologist referral, nephrologist referral. Likewise, the PCP's I've worked with feel reasonably comfortable managing bread and butter depression / anxiety spectrum. For most patients, it isn't a terribly complex diagnosis, they aren't gravely disabled, and SSRI's have a reasonable side effect profile. If they pick up on a possible history of manic symptoms, it'll get referred - I've never seen a PCP I've worked with start a mood stabilizer for a psychiatric diagnosis (not to say it doesn't happen anywhere or that it's necessarily inappropriate). The diagnosis, management, and side effect profile of the medications gets considerably more complex and it's reasonable to escalate resource utilization. PCP's are concerned about the overall well being of their patients, and that includes the psychosocial.

As far as psychologist rx, without getting into the nitty gritty of what the training should entail, whether or not there should be physician oversight, what their formulary should be, etc., it's not something I'm inherently opposed to - there's certainly a need and a potential benefit to be had.

 

[erg923]

Yes. I think they will. They'll also be better trained to know how to weed out depression and bipolar issues. They'll be better equipped to test for ADHD rather than acquiescing to moms just doctor shopping because their kid won't sit still in church. You pay for that whole hour on that one issue instead of "I need medication for blood pressure, diabetes, asthma, and pre-screened for the sleep study, and oh, by the way, I'm depressed, give me drugs" all within a 30 minute window, then schedule a follow up in a 3 months because they're all booked up until then.

Yeah, I think a psychiatrist will and should do better.

This is naive, and generally, inaccurate. Every sentence.

 

[erg923]

Why not? Doctors don't complain about "handling all the medical stuff" then outsource their work to people not specifically trained in medicine. Sounds like you should complaining to the system you work in, not to me. It's thoughts like this... that we're just some subset of doctor instead of our own profession uniquely qualified that keeps psychology second rate in everyone's eyes.

They care about the whole person... nnnn's MEDICAL needs. Emphasis on medical.

The absurdness of this was already adequately disputed, so I won't duplicate it, but I will add that such a monolithic attitude will not serve you well in this profession.

You (we) don't own mental health, and we never have. Living and working in a cillo leaves you and your patients limited. Collaborate. There is wealth of practice literature on this. Read it.

 

[473912]

PCP's don't complain about handling "all the medical stuff" because they don't do that. No one is capable of that. They handle what they feel they're capable of handling and refer out for additional services as they feel necessary. Bread and butter CHF, easily managed. CHF and chronic renal failure that's had repeat hospitalizations for acute decompensations... cardiologist referral, nephrologist referral. Likewise, the PCP's I've worked with feel reasonably comfortable managing bread and butter depression / anxiety spectrum. For most patients, it isn't a terribly complex diagnosis, they aren't gravely disabled, and SSRI's have a reasonable side effect profile. If they pick up on a possible history of manic symptoms, it'll get referred - I've never seen a PCP I've worked with start a mood stabilizer for a psychiatric diagnosis (not to say it doesn't happen anywhere or that it's necessarily inappropriate). The diagnosis, management, and side effect profile of the medications gets considerably more complex and it's reasonable to escalate resource utilization. PCP's are concerned about the overall well being of their patients, and that includes the psychosocial.

As far as psychologist rx, without getting into the nitty gritty of what the training should entail, whether or not there should be physician oversight, what their formulary should be, etc., it's not something I'm inherently opposed to - there's certainly a need and a potential benefit to be had.

That's exactly my point. Cardiac problems go to a cardiologist, renal go to those, ENT issues... osteo... pulmonology... They refer those diagnosis and problems out. The same should be true with a psychologist. I'm sure doctors feel comfortable doing a lot of things, but that doesn't mean they should be doing them. PCP's aren't the only people that are concerned about the overall person, and when it comes to the mundane stuff that's great. But farming the specific things out to people better trained should be part of it too. Especially in a system where doctors have to split insurance payments between people they refer to, there's an incentive NOT to do that to make more money.

PCP's, in my experience, are already overbooked and scheduled tightly. You can't assess and monitor mental changes from going on drugs if you're seeing only the patient only for 30 minutes every 3 months.

 

[473912]

This is naive, and generally, inaccurate. Every sentence.

Oh cool, thanks. Well said. I find you jaded and illogical. Every sentence. You're not the only one with experience, Erg.

The absurdness of this was already adequately disputed, so I won't duplicate but I will add that such a monolithic attitude will not serve you well in this profession. You (we) don't own mental health, and we never have. Living and working in a cillo leaves you and your patients limited. Collaborate. There is wealth of practice literature on this. Read it.

I never said you shouldn't collaborate, and I never said we owned mental health. I've said a wealth of this on my posts. You should read it.

 

[Cytarabine]

That's exactly my point. Cardiac problems go to a cardiologist, renal go to those, ENT issues... osteo... pulmonology... They refer those diagnosis and problems out. The same should be true with a psychologist. I'm sure doctors feel comfortable doing a lot of things, but that doesn't mean they should be doing them. PCP's aren't the only people that are concerned about the overall person, and when it comes to the mundane stuff that's great. But farming the specific things out to people better trained should be part of it too. Especially in a system where doctors have to split insurance payments between people they refer to, there's an incentive NOT to do that to make more money.

PCP's, in my experience, are already overbooked and scheduled tightly. You can't assess and monitor mental changes from going on drugs if you're seeing only the patient only for 30 minutes every 3 months.

You must have skimmed over where I said PCP's manage bread and butter CHF. They can manage plenty more than that too. Are you saying they should refer patients with a cold sore to an immunologist?? There's that off chance it's an initial presentation of Behcet's or Crohn's, and the subspecialist is likely to pick up on it quicker. If everything was referred out, the system would be even more horribly fragmented and costly than it is now.

Out of curiosity, since you said 30 minutes every 3 months is inadequate to monitor chronic psychopharm, how often do you think psychiatrists are seeing their long term patients and how long do you think those visits are?

 

[473912]

You must have skimmed over where I said PCP's manage bread and butter CHF. They can manage plenty more than that too. Are you saying they should refer patients with a cold sore to an immunologist?? There's that off chance it's an initial presentation of Behcet's or Crohn's, and the subspecialist is likely to pick up on it quicker. If everything was referred out, the system would be even more horribly fragmented and costly than it is now.

Out of curiosity, since you said 30 minutes every 3 months is inadequate to monitor chronic psychopharm, how often do you think psychiatrists are seeing their long term patients and how long do you think those visits are?

You must have skimmed over where I already agreed that PCP's should manage the typical stuff. A cold sore is typical. Hypertension is typical. ADHD meds that affect mood, behavior, and development is not typical and should be handed out on usually just a parent's or a teacher's say so. There are steps that should be taken before meds are doled out. I know first hand that parents doctor shop and PCP's diagnose and treat mental illnesses hastily. Not because they're bad people. Moving patients in and out is pretty much what they have to do unfortunately.

I keep bringing up 30 minutes and 3 months because throughout my time in the medical field, that's typically the time allotted to patients, and in in my own recent experiences, that's the time slot and time frame that I've seen personally. And to answer your question, from the dozens of LPC's, MFT's, psychologists, and psychiatrists I know, half of which I know on a first name basis, they see their patients for longer and more frequently then 30 minutes and 3 months. And none of which would hesitate to not only refer out people outside their specific training or refer out for testing.

I'm not saying psychs shouldn't collaborate. I'm all for it for sure. I can't wait to collaborate. Please don't misunderstand.

 

[erg923]

You're not the only one with experience, Erg

.
Is that so? You've been practicing for how long now?

I would like to show your responses on thus matter the docs here today. I will return with their responses.

 

[wesleysmith]

Oh, snap!

 

[smalltownpsych]

Is there any real literature that supports the idea that people that use marijuana are not productive?

I haven't looked at this specifically in a long while but from what I recall the two most significant effects of chronic use are short-term memory and motivation. I knew some guys that were going to study this further but then they never got around to it.
There are always going to be people that can use various substances without experiencing the negative effects. That doesn't invalidate those effects.

 

[473912]

.
Is that so? You've been practicing for how long now?

I would like to show your responses on thus matter the docs here today. I will return with their responses.

I've been clinical manager for respiratory and sleep labs at major hospitals and labs across the country for 10 years. That's contact with hundreds of doctors throughout my career and hundreds of patients every single year. I've started and designed more labs than I can remember and helped write P&P for several major hospitals. The medical directors for some labs were psychiatrists that I am I'm still on the first name basis with. Another teaches at Stanford. I'm not pulling this out of my ass.

Don't bother responding. You've made up your mind when you don't know a thing about me. It's this dismissive condescension and not my your differing opinion why I'm ignoring your posts from now on. I don't have time to get into a d--- waving contest every time I bring up a point.

 

[erg923]

I've been clinical manager for respiratory and sleep labs at major hospitals and labs across the country for 10 years. That's contact with hundreds of doctors throughout my career and hundreds of patients every single year. I've started and designed more labs than I can remember and helped write P&P for several major hospitals. The medical directors for some labs were psychiatrists that I am I'm still on the first name basis with. Another teaches at Stanford. I'm not pulling **** out of my ass.

Don't both responding. You've made up your mind when you don't know a thing about me. It's this dismissive condescension and not my your differing opinion why I'm ignoring your posts from now on. I don't have time to get into a d--- waving contest every time I bring up a point.

I noticed none of that is running a primary care psychology service? No need to be such a drama queen about it, geez.

 

[473912]

I haven't looked at this specifically in a long while but from what I recall the two most significant effects of chronic use are short-term memory and motivation. I knew some guys that were going to study this further but then they never got around to it.

Ba-dum Tish....