Do docs look down on Psychs

[sasevan]

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I do agree with these distinctions, but do still feel that clearly identifying the context in which you are seeing the patient is important. - I think most of us do it anyway; you would never approach the bedside for the first time, give your title/name only, and start launching in to your business without first adding why you're seeing them and what you'd like to talk about/do.

I absolutely agree.👍

 

[QPublic]

Unfortunately, I guarantee that it will happen. But you can correct it. But it will happen. IMO, not enough people try to correct. Frankly, it's an awkward process.

I plan on working in a hospital setting (medical psychologist), and i'll be damned if someone tries to call me "Bob" instead of "Dr. Smith".

-t

 

[zbombvt]

I'll add my two cents. After graduating from college I became involved in two psychiatric academic programs. The first with adults, the second with children. The second setting had a mix of psychiatrists and psychologists and from what I can tell everyone seemed to be treated as equals, with equally valued opinions. In my first setting I noticed less of this harmony. While certainly no one was flat out rude to each other, I noticed that some psychiatrists were not amused or impressed when psychologists suggested that communal patients be given antidepressant X. The psychiatrist felt the psychologist was stepping over the boundaries between the two professions.

Take it for what its worth.

 

[QPublic]

I am finding myself unhappy with my current hospital position (which I just started a few months ago), where I believe that Psychology is given lip service. I'm not sure if this is at all related to the fact that in addition to a few psychologists (myself included), there are several masters-level people in the Psychology department. Personally, I feel that dilutes our professional identity, or of the department.

Anyhow, the reason for my posting is to ask if any other psychologists here have thoughts on how to find or discern hospitals where psychologists function the way we are trained to, and treated as the doctors that we are.
Thoughts?

 

[Therapist4Chnge]

Unfortunately, I guarantee that it will happen. But you can correct it. But it will happen. IMO, not enough people try to correct. Frankly, it's an awkward process.

I'm in a medical setting (still in training, so I'm not licensed yet, etc), and it is a daily occurance. I've had an excellent experience with the psychiatrists on staff (we use an integrated team approach), but the problem does not reside on the psychiatry side, but on the psychologist side. All first names around the room (mix of MS, PhD, PsyD, nurses, etc)....then Dr. XXXXXXXXX for the psychiatrists. They assert themselves, but the psychologists do not. It seems like a small thing, but I believe it is indicative of larger problems.

-t

 

[Logic Prevails]

I am finding myself unhappy with my current hospital position (which I just started a few months ago), where I believe that Psychology is given lip service.

Can you give a few examples of how you think your role is being downplayed? I hope to work in a multidiciplinary setting when I get out and would like to hear about these experiences.

My feeling (maybe a nieve one) is that if you have the knowledge, you can talk the talk, and walk the walk - people will respect you and what you have to offer. If other people that you work with don't live up to your standard or the potential you see for the department you work in, then find a way to fire them up and get them to live up to their potential - or find a way to get them out. If you outshine everyone in your area, then I would think the "higher powers" would take notice and wonder why the other psychologists aren't as good... maybe they will come to the conclusion that one excellent psychologist is better than two bad ones and a couple ineffective masters level practitioners.

That would be my take.

 

[QPublic]

I'm in a medical setting (still in training, so I'm not licensed yet, etc), and it is a daily occurance. I've had an excellent experience with the psychiatrists on staff (we use an integrated team approach), but the problem does not reside on the psychiatry side, but on the psychologist side. All first names around the room (mix of MS, PhD, PsyD, nurses, etc)....then Dr. XXXXXXXXX for the psychiatrists. They assert themselves, but the psychologists do not. It seems like a small thing, but I believe it is indicative of larger problems.

-t

I thoroughly agree with you. The name thing only seems to be an issue with non-physicians, in my experience (ie, physicians respect the title for psychologists). And I agree, I think people say ah, that's no big deal, but it is part of the much larger picture.

 

[QPublic]

Sure... psychology services are requested for a good percentage of the patients, but the evaluations/chart notes appear to go unread by the attending physicians (particularly worrisome when the patient has a delirium!). I quickly found this to be evident after starting here, and mentioned it conversationally to the director of the psychology dept... when most of the patients you're consulted on are labelled (I hesitate to call it diagnosed, because there seems to be an absence of criteria!) as depressed or anxious, and started on psychotropics before you're consulted... and you find that they're not... and neither the labels nor the medications change...
I acknowledge that I'm sensitive to these issues, but I don't think my expectations are unreasonable. I think that a big issue is that I see my role as involving an important component of assessment/diagnosis, not just hand-holding or counseling (I'm not equating these two).
With regard to the masters-level clinicians, I wouldn't call them ineffective, but clearly there are differences in skill sets and training between us and them.

At my previous position, I was the only psychologist on staff, and I think I did a pretty good job educating and shaping the staff to understand the psychologist's role and competencies (as well as using the appropriate title of doctor).

Can you give a few examples of how you think your role is being downplayed? I hope to work in a multidiciplinary setting when I get out and would like to hear about these experiences.

My feeling (maybe a nieve one) is that if you have the knowledge, you can talk the talk, and walk the walk - people will respect you and what you have to offer. If other people that you work with don't live up to your standard or the potential you see for the department you work in, then find a way to fire them up and get them to live up to their potential - or find a way to get them out. If you outshine everyone in your area, then I would think the "higher powers" would take notice and wonder why the other psychologists aren't as good... maybe they will come to the conclusion that one excellent psychologist is better than two bad ones and a couple ineffective masters level practitioners.

That would be my take.

 

[50960]

I am the only psychologist on staff where I work, and that has been the case for the past few years. My experience is that if you introduce yourself to patients as Dr. ?, and physicians call you Dr the others will come along.

 

[Logic Prevails]

psychology services are requested for a good percentage of the patients, but the evaluations/chart notes appear to go unread by the attending physicians (particularly worrisome when the patient has a delirium!). I quickly found this to be evident after starting here, and mentioned it conversationally to the director of the psychology dept...

I think you made the right choice in going to your director. I would bring it up again if you think your point was not taken.

when most of the patients you're consulted on are labelled as depressed or anxious, and started on psychotropics before you're consulted... and you find that they're not... and neither the labels nor the medications change...

Yeah, this would grate me too. I would ask the director if you could hold a discussion during clinical rounds or something - about "diagnosing" depression & anxiety, how "quick observations" can be wrong, and what psychology has to offer. If there are people that you work with who are particularly neglectful and careless, I would challenge them on a regular basis (in a professional way of course) - but that's the kind of person I am.

With regard to the masters-level clinicians, I wouldn't call them ineffective, but clearly there are differences in skill sets and training between us and them.

I was just wondering what you were really getting at with your comments about your dissatisfaction being possibly related to the presence of masters level clinicians and how it "dilutes the profession." Do you think they try to do more than they should? Is this based on what you see as their actual knowledge/ability, or based on their credentials?

The reason I ask these questions is because I know a few masters level clinicians (a minority) who are much more competent than the average PhD - yet they are constantly looked down upon and treated as second class citizens in multidiciplinary settings. I just think you want to be careful about how you perceive them, though it is clear that you perceive them to have some contributions to your team.

 

[ProZackMI]

Some really good posts in this thread and some very good points. As a former psychiatrist who is now practicing law, I will tell you that based on my experience, the question of whether psychiatrists (or, more specifically, physicians in general) "look down" upon psychologists is not a clear-cut, easy to answer question.

First, one's reaction toward, and interaction with, other professions is usually predicated upon that individual's personality (i.e., laidback, arrogant, uptight, insecure, etc.), background (professional and personal), and history of personal interaction with the specific profession in question. Not all physicians are arrogant, but many do see themselves as being the "top" of the health care food chain. Most hospitals, clinics, and CMH facilities support this doc-at-top model and it's reflected in the institutional culture.

A secure, competent, and laidback physician is generally going to accept other professionals and judge them based on competence and professionalism. Others will automatically assume the psychologist is somehow inferior because he/she lacks an MD/DO.

I have seen examples of psychiatrists and other physicians who do indeed look at psychologists as being academics, soft social scientists, or puffed up quacks. I have also seen examples of psychiatrists who look up to and respect psychologists.

When I was a resident at the University of Michigan, one of my preceptors was a clinical psychologist/associate professor of psychology/psychiatry. PhD from Harvard, master's from Yale, MPH from Hopkins. Brilliant guy. Very laid back, very approachable. One resident, an MD from Michigan (thus, arrogant and cocky) was concerned that our preceptor was "not a real doctor and merely an academic egghead". The preceptor-psychologist responded sternly, "Excuse me, but I have a doctorate from Harvard. I have a real doctorate, not some puffed up professional degree in body mechanics. You, sir, have failed this course and with that attitude, you'll end up mending crackwhores in some Godforsaken inner-city ER. Everyone here is an equal." 🙂

So, I guess my point is, how you hold yourself out to others, how you use your title, and how you choose to interact with patients and professionals will largely impact how you are in turn treated. If you wear Birkenstocks and ponytails rather than suits and ties, shun white coats, and shy away from medical jargon and procedures, you'll be treated differently from physicians.

 

[ProZackMI]

Also, personally, I have nothing but respect for most doctorally-prepared psychologists. I will say, however, that many of them are "too nice" and don't use their doctoral title and many appear to be rather...informal (for lack of a better word). I've seen a few who don white coats, wear nice suits, and in general, appear very professional, whereas I have also seen some wear sandals, ponytails, facial hair galore, and rumpled Dockers, who look like social workers or assistant professors, not medical professionals.

I also hate to admit this, but I do look down upon master's level psychologists who, more often than not, function as psychometrists or CMH clinicians. Even MSWs tend to look down upon them.

Perhaps if more of the PhDs insisted on being called "Doctor" and held themselves out as being medical providers, other professionals would treat them better. You don't see dentists and optometrists who use their first names in professional settings, do you? Most dentists wear some form of smock or lab coat, etc. How you hold yourself out to others is very important in terms of professional image and status. I notice that more PsyDs than PhDs insist on being called "Doctor" and usually dress more professionally. I'm not sure why this is, but it does make an impact.

My two cents.
Zack

 

[50960]

LOL..I agree Snow, but you are about as narcissistic as I am. Not everyone in our field is this way PsyD or PhD, and it leads to people being treated as referral dependent practitioners like SLP, OT, PT...and hmmmm hospital based neuropsychs!!! JK.😀

 

[Therapist4Chnge]

LOL..I agree Snow, but you are about as narcissistic as I am. Not everyone in our field is this way PsyD or PhD, and it leads to people being treated as referral dependent practitioners like SLP, OT, PT...and hmmmm hospital based neuropsychs!!! JK.😀

My narcissism serves me well in this regard. 😀

-t

 

[QPublic]

I appreciate your comments on this matter, Zack. Interesting to hear from a different vantage point. I agree with you about many psychologists being too casual (in terms of dress, introduction, etc.) in settings that are otherwise more formal (eg, medical settings). I think that this tendency is so widespread, and that non-psychologist, non-physician colleagues that work in the same settings often expect the casual demeanor. It can be challenging at times to use the professional identity without having others assume that you're just arrogant (well, nothing wrong with a little arrogance;-).

Also, personally, I have nothing but respect for most doctorally-prepared psychologists. I will say, however, that many of them are "too nice" and don't use their doctoral title and many appear to be rather...informal (for lack of a better word). I've seen a few who don white coats, wear nice suits, and in general, appear very professional, whereas I have also seen some wear sandals, ponytails, facial hair galore, and rumpled Dockers, who look like social workers or assistant professors, not medical professionals.

I also hate to admit this, but I do look down upon master's level psychologists who, more often than not, function as psychometrists or CMH clinicians. Even MSWs tend to look down upon them.

Perhaps if more of the PhDs insisted on being called "Doctor" and held themselves out as being medical providers, other professionals would treat them better. You don't see dentists and optometrists who use their first names in professional settings, do you? Most dentists wear some form of smock or lab coat, etc. How you hold yourself out to others is very important in terms of professional image and status. I notice that more PsyDs than PhDs insist on being called "Doctor" and usually dress more professionally. I'm not sure why this is, but it does make an impact.

My two cents.
Zack

 

[LM02]

Perhaps if more of the PhDs insisted on being called "Doctor" and held themselves out as being medical providers, other professionals would treat them better.

Unfortunately, there are certain institutional settings in which psychologists are proscribed from being called "Dr." One example of this is (was?) at Yale Medical School. I have a colleague who used to work there, with a doctorate, and he was told that - in order to "minimize patient confusion" - only MDs could be addressed as "doctor." Instead, he was "Mr." I can't even imagine what would have happened if he had put on a white coat.

So it works both ways....

ETA: Also, this may reflect our training quite a bit. In most clinical PhD programs, graduate students start their therapy training in the 2nd year of grad school. To take an example from my experience, I saw patients for a good 5 years (grad school + internship) without a doctorate. So I couldn't be called "doctor," but I personally really disliked being called "Ms. LM02." So the end result was that my patients called me by my first name during this time. By the time I got my PhD, I was kind of over it - I usually introduce myself as Dr. LM02, but don't really care too much if a patient refers to me by my first name.

 

[50960]

I agree LMO2, and I do the same. I wonder if Yale DDS, DPM and DOs are called Dr?? I simply would not have allowed that to happen as it is blatant discrimination, and psychologists are as much, if not more Drs than MDs. I work exclusively in medical settings, am always called Dr by everyone except masters level counsellors, quite consistently.

😎

 

[PsiKo]

I agree LMO2, and I do the same. I wonder if Yale DDS, DPM and DOs are called Dr?? I simply would not have allowed that to happen as it is blatant discrimination, and psychologists are as much, if not more Drs than MDs. I work exclusively in medical settings, am always called Dr by everyone except masters level counsellors, quite consistently.

😎

As Paul Simon said: "You can call me Al." Or is it Alan? 😉

 

[ProZackMI]

I agree LMO2, and I do the same. I wonder if Yale DDS, DPM and DOs are called Dr?? I simply would not have allowed that to happen as it is blatant discrimination, and psychologists are as much, if not more Drs than MDs. I work exclusively in medical settings, am always called Dr by everyone except masters level counsellors, quite consistently.

😎

Good point. There might other non-physicians with professional or academic doctorates affiliated with a medical school or medical center. I would say the YMS "directive" restricing the title "Dr" to MDs (or physicians) only was more of an informal, unwritten policy enacted by physicians rather than some written codified policy or pseudo-statute. In other words, if a PhD/PsyD insisted on being "doctor", what were the reprecussions, if any?

At the University of Michigan Med Center, there was no such rule. PhDs, PharmDs, dentists, optometrists, psychologists, biomed scientists, pods, and doctors of public health were all referred to as doctor. Guess what? No patient was ever confused, nor did any patient ever die or sustain an harm resulting from confusion.

Most professionals introduce themselves by their title and name and then speciality. Example: "I'm Dr. Smith, pediatric psychologist, and I'll be examining your son today."

 

[ProZackMI]

I appreciate your comments on this matter, Zack. Interesting to hear from a different vantage point. I agree with you about many psychologists being too casual (in terms of dress, introduction, etc.) in settings that are otherwise more formal (eg, medical settings). I think that this tendency is so widespread, and that non-psychologist, non-physician colleagues that work in the same settings often expect the casual demeanor. It can be challenging at times to use the professional identity without having others assume that you're just arrogant (well, nothing wrong with a little arrogance;-).

In a private practice setting, arrogance can be off-putting to patients. However, in a clinic or hospital setting, you should conform to the dominant culture. Maybe a white coat is a bit much for some psychologists (even for many psychiatrists!), but a good psychologist should know that he/she won't be considered equal partners on the mental health team if they act in a way that casts them as being somewhat or completely inferior to psychiatrists.

You might not be able to change things like financial compensation, but you sure as hell can change how others perceive you. Arrogance in those settings might go a long ways.

 

[snyder_phd]

This is because all Psychologists do not have their doctrate.

 

[Therapist4Chnge]

This is because all Psychologists do not have their doctrate.

😕

I'm pretty sure to be considered a psychologist, you HAVE to have your doctorate; I've never heard of a psychologist not having one.....

Even in I/O....a psychologist is still a doc. level (they have MS level I/O's, but they aren't called psychologists)

-t

 

[PsiKo]

😕

I'm pretty sure to be considered a psychologist, you HAVE to have your doctorate; I've never heard of a psychologist not having one.....

Even in I/O....a psychologist is still a doc. level (they have MS level I/O's, but they aren't called psychologists)

-t

They're a dying breed, but practicing master's level licensed psychologists do exist, at least in some states -- they were grandfathered in.

Here's one -- John Rosemond.

 

[CatsandCradles]

I'm a fourth year medical student, and I'm gonna give you the SURGEON'S take on this.

I must say that I had a really $hitty experience in my psychiatry rotation. I love people and came into the rotation with a strong sense of empathy and care for people in the wards who had a tough luck at the races and were branded with PSYCHIATRIC ILLNESS. I thought that psychiatrists would be there for them to talk things out and be a friend to these people. I would stay until 6 or 7PM on my psych rotation to talk to my patients and understand them, while my attending would bolt at 3pm. The only time they spent with these patients was 3-4 minutes during morning rounds to make sure they haven't slit their wrists. On outpatient services, NPs would see the patients with the occasional visit by the psychiatrists. I found them to be pillpushers and writing Haldol/Ativan orders to sedate the patients until they could get out of the hospital by 3PM. They frequently laughed at the patients and seemed very callous and judgemental of them. I saw no compassion or understanding at all. I'm going into ENT and then Plastic Surgery and I found that even the surgeons are FAR more understanding of their patients than psychiatrists.

Now, on to the PSYCHOLOGISTS...
I think they are much better than the psychiatrists. While psychiatrists are attendign cushy drug lectures and pushing pills and sizing up patients. I found that our consult psychologist was really there for the patietns and actually hearing them out. I think that the ability to prescribe has really f#$@ed up the minds of the psychiatrists that they think a pill is the quick fix. The most I learned about the human mind was from a PSYCHOLOGIST not a psychiatrist.

As a future Plastic/Reconstructive Surgeon, I am going to frequently consult a PSYCHOLOGIST to help me better select and screen my patients and understand them as well. I admit that sometimes it is hard to spend enough time to fully understand patients with OR responsibilities and followups and for this reason, as a surgeon, we surprisingly rely heavily on psychologists. Yes, in the end I became very bitter towards psychiatrists and their insistence in solving everything with a pill and a swig of Haldol/Ativan. This really made me appreciate psychologists perspecive on the other hand in their focus on talking to the patients rather than doping them up.

This comment is right on the spot.

At my school we have a secret joke. I'll share it with all of you pychologist here.

"The surgeons are the doctors who do everything, but they don't know anything. The internal medicine doctors know everything but don't do anything....and the psychiatrist don't know anything and they don't do anything."

I know, it's a mean joke. 🙂 So that's why I think psychologist > pyschiatrist.