Do MD's fear psych being overrun by NP's?

[Sushirolls]

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Telemedicine is a neutral tool. Some patients love it. Some hate it. Some use it because of logistics but they hate it.
More often than not, I have a patients complain about telemedicine with the therapist and they want that in person.
As medication focused Psychiatrist, people are more receptive to telemedicine with me.

 

[MedMan80]

NP’s also struggle with setting limits, at my organization they often engage with patients demanding benzos over the messaging system instead of calling and saying no means no. They also fail to see the concept of do not harm (had an NP continually prescribe adderall IR to a meth user)

 

[Sushirolls]

Let's not forget the hugs. Witnessed few too many of those.

 

[nexus73]

Let's not forget the hugs. Witnessed few too many of those.

I had an NP telling a patient she was beautiful. As in a female NP, telling a depressed borderline patient she was beautiful to lift her spirits. Seemed...odd.

 

[WisNeuro]

Meh, we can all find anecdotes of boundary crossing without resorting to confirmation bias towards one profesision. I can easily find multiple examples of psychiatrists, psychologists, etc having sex with their patients within the last year or so in my local area.

 

[Jules A]

Meh, we can all find anecdotes of boundary crossing without resorting to confirmation bias towards one profesision. I can easily find multiple examples of psychiatrists, psychologists, etc having sex with their patients within the last year or so in my local area.

I agree and while the soft midlevel education and lack of psychiatric nursing experience should be a hard stop in my opinion the poly-pharm handiwork and boundary violations by psychiatrists that I know of is egregious also.

 

[Sushirolls]

The psychiatrists I know don't have boundary violations.

 

[WisNeuro]

The psychiatrists I know don't have boundary violations.

I would hope that you try and maintain a fairly ethical colleague group, but are implying that it doesn't exist? I mean, I can say that none of the 4 NPs in my social circles have any public ethical investigations and it carries the exact same weight as this comment.

 

[Sushirolls]

I would hope that you try and maintain a fairly ethical colleague group, but are implying that it doesn't exist? I mean, I can say that none of the 4 NPs in my social circles have any public ethical investigations and it carries the exact same weight as this comment.

Nope. Not implying perfect. Just offering a counter balance, an N of 1 to the observations of others that there are random samplings of no issues. A snap shot from this thread one would hopefully not draw a more dire conclusion that boundary issues are rampant and peppered in all clinical environments across the whole country. That was my intent with that post.

To further expand on what I think...

I hold the opinion that boundary violations are not instructed as well if at all for ARNPs. I could argue to national rate of sexual boundary violations could be higher or lower in ARNPs relative to Psychiatrists, but would be difficult get quality data for this to see how it pans out. But lower level boundary violations, I believe are more common in ARNPs simply because of a lack of training. I believe with the training this could be improved upon, but I'm not holding my breadth anytime soon for that.

 

[WisNeuro]

Nope. Not implying perfect. Just offering a counter balance, an N of 1 to the observations of others that there are random samplings of no issues. A snap shot from this thread one would hopefully not draw a more dire conclusion that boundary issues are rampant and peppered in all clinical environments across the whole country. That was my intent with that post.

To further expand on what I think...

I hold the opinion that boundary violations are not instructed as well if at all for ARNPs. I could argue to national rate of sexual boundary violations could be higher or lower in ARNPs relative to Psychiatrists, but would be difficult get quality data for this to see how it pans out. But lower level boundary violations, I believe are more common in ARNPs simply because of a lack of training. I believe with the training this could be improved upon, but I'm not holding my breadth anytime soon for that.

Definitely an n issue nationwide as the number of providers would differ by specialty. I'd love to see data, but from my experience, I'd posit that when looked at per capita, the numbers are probably fairly similar across professions. When it comes to "lower level boundary" violations, the lines become fairly blurred, as there are definitely things that some are ok with, and some not, even within the same specific guild. This would be an easy enough survey to run on attitudinal differences across MH positions with respect to behaviors within a therapeutic context.