NM or LA psychologist

[PublicHealth]

Where'd everyone go? We're still waiting to hear from a prescribing psychologist. Anyone out there?

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[PsychEval]

While we are continuing to wait, I came across an interesting video regarding the need for prescribing psychologists in the state of Illinois. I have attached the link for your enjoyment and comments.



http://www.illinoispsychology.org/prescribing.htm

 

[PublicHealth]

While we are continuing to wait, I came across an interesting video regarding the need for prescribing psychologists in the state of Illinois. I have attached the link for your enjoyment and comments.

http://www.illinoispsychology.org/prescribing.htm

Thank you. I've seen this before and wonder what effect (if any) this video had on legislation for prescriptive authority in Illinois. What is the status of this issue in IL?

 

[PsychEval]

Great questions, I don’t know. However, identifying the issues does have a positive influence on legislation for prescriptive authority (DOD, Guam, New Mexico, and Louisiana). I am impressed with the efforts in IL. All of this is a political process. Historically, one of the reasons medical doctors obtained control of the prescription pad was the growing political influence of the American Medical Association and their ability to pass laws limiting prescriptive authority. We can’t rely on the American Psychological Association for positive change, it must happen at the local level. It is nearly impossible to be interested in and involved with RxP and not be involved with the political process.

 

[edieb]

In IL, the bill was defeated by one or two votes this year. Also, the bill was defeated in HI by only one vote.

There is an article about the fight between psychiatry and psychology in IL on psych.org

 

[50960]

Shouldn't be a fight........

 

[PublicHealth]

In IL, the bill was defeated by one or two votes this year. Also, the bill was defeated in HI by only one vote.

What is the source of this information? I recall reading something about this in Psychiatric News, but wasn't aware of these details. Any word on other states?

Here's Jack Wiggin's take on the issue:

"It was disappointing that no new legislation for prescriptive authority was passed by state legislatures this year. Upon reflection this may not be surprising with all of the negative publicity the pharmaceutical industry has received in the past year. The concealing of data about negative research findings of drug companies and apparent collusion with government sponsored research has placed a cloud over the FDA. This has caused physicians and legislators to be more circumspect about medications and the prescribing practices of physicians. Also contributing to this suspicion and increased caution is news about the suicide risk increase in children and adults taking SSRI psychotropics, the FDA withdrawing approval of Vioxx, and negative publicity about the risk of statins and other cardiovascular medications.

Actually, there is much good news about RxP. Although no new laws were passed, we did not suffer any major defeats. The opposition should have had a field day attacking the dangers of prescriptive authority with these powerful medications. Instead, legislators drew back and said this is a serious issue requiring more study. Additional hearings on RxP were scheduled in Hawaii, Missouri and Tennessee. Canada, like Missouri, reports positive findings and a growing momentum for RxP when surveying the members of their respective organizations. Alabama and Georgia are refocusing on RxP training. Fairleigh Dickens is collaborating with them. Alliant University has a RxP training program operating in Oregon.

Negative news about medications , especially psychotropics, should be a selling point for prescriptive authority for psychologists since we are more apt to take patients off medications and need prescriptive rights empower psychologists to do so. We need to press this point as forcefully as we can. Otherwise, psychology will be discounted as a mere "wannabe" psychiatric profession.

The negativity of the pharmaceutical news is compounded by the general negativity of news reporting on the economy, Iraq, the sensationalizing of crimes against persons. Some days, the print media, TV and radio seem to compete for attention and advertising dollars with one another by which one can report the most negative stories. I have watched the consumer confidence index fluctuate with the degree of negativitity that is reported by the media. Even when there is good news to report, journalists seem feel that it is their duty to find ways to discount the value or the importance of something positive. It does not help that the Democrats and Republicans keep trying to blame one another for what is wrong by mudslinging.

It psychology's task to bring hope to people and to the public. This seems to be the main theme of Ron Levant in his APA Presidential campaign of making psychology a household word. We can all help in this campaign by sending email messages to our Congressional Representatives to ward off pending Medicare cuts for doctors by reminding them that mental health care is already discounted to 50% copayment from 80% reimbursement with a 20% copayment for other health conditions. Go to the APAPO Legislative Action website at http://www.APApractice.org for additional information about how facilitate APA efforts is this legislative effort."

Source: http://www.division55.org/Readers/Current.htm

 

[duce444]

I am an internal medicine resident and I just started reading forum. I see some glaring problems that havn't been mentioned here regarding psychologists and prescription rights. The problem is the inability to RULE OUT organic, neurologic, medical etiologies of mental illness. I can't see how a psychologist without any medical training can possibly diagnose depressive symptoms caused by hypothyroidism, stroke, beta-blockers, multiple sclerosis, etc. Or for that matter evaluating a patient's liver and renal function, especially in patients who are on multiple other medications. Unless you can effectively manage the possible side-effects of the drugs being prescribed...you SHOULD NOT have prescription priveleges. I have seen more than one patient on hemodialysis after overdosing on lithium. I am quite certain that none of my colleagues would ever refer to a psychologist for medications. It just doesn't make any sense. I know that my colleagues in psychiatry have spent at least a year on the medical wards during school and residency. For that matter, nurses and PA have at least several years of direct hospital clinical experience. Psychologists serve an important function and all but this is ridiculous.

 

[50960]

Troll elsewhere...

 

[PublicHealth]

The problem is the inability to RULE OUT organic, neurologic, medical etiologies of mental illness. I can't see how a psychologist without any medical training can possibly diagnose depressive symptoms caused by hypothyroidism, stroke, beta-blockers, multiple sclerosis, etc. Or for that matter evaluating a patient's liver and renal function, especially in patients who are on multiple other medications.

Have you thoroughly evaluated the postdoctoral curriculum for prescribing psychologists or are you simply stating your opinion without looking at the facts? I encourage you to read some more on this topic before speaking your mind. Here's a start:

http://www.asppb.org/publications/guidelines/paq.aspx

http://www.alliant.edu/wps/wcm/conn...San+Francisco+&+Online+MS+Psychopharmacology/

http://www.division55.org/

http://pn.psychiatryonline.org/cgi/content/full/psychnews;39/15/1

There's more, but I have to study. For the record, I'm a second-year medical student interested in psychiatry.

 

[duce444]

Its ludicrous to think that one year of pharmacology or 10 years of pharmacology will help you to understand medical/neurologic conditions. There is no classroom substitute for direct clinical medical training. I am sorry to say, but no physician would allow their patient to be medicated by a non-medical professional. Good luck finding a hospital that will give psychologists priveleges to administer meds. It just sounds totally absurd. Why not take weekend surgery courses and perform surgery? Im not intending to flame this thread. But the arguments being made here are arguments that anyone and everyone that takes a training course should have prescription rights. I mean thats essentially the problem. The lab scientist, the social worker, the college professor....they can all get "clinical" experience by taking a course right? I know PhD biochemists who know far more about pharmacology then I will ever care to know. But I would never go to them if I have pneumonia. There have to be some form of standards because drugs can and do kill people.

 

[PsychEval]

Study: Doctors limited in Rx training
WASHINGTON (AP) — With abuse of prescription drugs growing rapidly, many doctors and pharmacists say they have received limited training in dealing with pain-relievers, stimulants, tranquilizers and other controlled prescription drugs.
One factor behind the growth is that people easily can get these drugs from doctors, friends, relatives and through the Internet, according to a study by the National Center on Addiction and Substance Abuse at Columbia University.
Relying on various government reports, the study cited rapidly rising rates of abuse of prescription drugs, especially among teenagers.
About 15 million people in the U.S. abused controlled prescription drugs and the amount of abuse has gone up sharply over the past decade among all adults and especially among teens, according to the center's analysis of federal data on drug use.
Prescription drug abuse is defined in the study as the taking of prescription drugs not prescribed for the user or use of prescription drugs taken only for the experience or feeling it causes.
"We have an epidemic of abuse of painkillers," said Joseph Califano Jr., the center's chairman and president. "The problem with teens is a far more serious problem than anyone has ever realized."
Many doctors and pharmacists surveyed by the center said they have received only limited training in prescribing drugs.
Four in 10 doctors said they received no training in medical school on prescribing controlled substances; more than one-half received no training on identifying prescription drug abuse or addiction. Three-fourths said they had no training in medical school identifying diversion of prescription drugs for illicit purposes.
Four in 10 pharmacists say they have received no instruction since pharmacy school in dispensing prescription drugs. Almost one-half said they have received no instruction since pharmacy school in identifying prescription drug abuse or diversion of prescription drugs.
The separate polls of 979 physicians and 1,030 pharmacists were conducted during the summer of 2004 and each has a margin of error of plus or minus 3 percentage points.

 

[PublicHealth]

Study: Doctors limited in Rx training
WASHINGTON (AP) — With abuse of prescription drugs growing rapidly, many doctors and pharmacists say they have received limited training in dealing with pain-relievers, stimulants, tranquilizers and other controlled prescription drugs.
One factor behind the growth is that people easily can get these drugs from doctors, friends, relatives and through the Internet, according to a study by the National Center on Addiction and Substance Abuse at Columbia University.
Relying on various government reports, the study cited rapidly rising rates of abuse of prescription drugs, especially among teenagers.
About 15 million people in the U.S. abused controlled prescription drugs and the amount of abuse has gone up sharply over the past decade among all adults and especially among teens, according to the center's analysis of federal data on drug use.
Prescription drug abuse is defined in the study as the taking of prescription drugs not prescribed for the user or use of prescription drugs taken only for the experience or feeling it causes.
"We have an epidemic of abuse of painkillers," said Joseph Califano Jr., the center's chairman and president. "The problem with teens is a far more serious problem than anyone has ever realized."
Many doctors and pharmacists surveyed by the center said they have received only limited training in prescribing drugs.
Four in 10 doctors said they received no training in medical school on prescribing controlled substances; more than one-half received no training on identifying prescription drug abuse or addiction. Three-fourths said they had no training in medical school identifying diversion of prescription drugs for illicit purposes.
Four in 10 pharmacists say they have received no instruction since pharmacy school in dispensing prescription drugs. Almost one-half said they have received no instruction since pharmacy school in identifying prescription drug abuse or diversion of prescription drugs.
The separate polls of 979 physicians and 1,030 pharmacists were conducted during the summer of 2004 and each has a margin of error of plus or minus 3 percentage points.

Good point.

 

[PsychEval]

Shouldn't be a fight........

I agree.

 

[50960]

I can think of several things that show you are trolling, but that is another point. Your ignorance on this issue is showing. Regardless of your beliefs about RxP, most don't rattle on until they at least know that prescribing psychs take 1 year clinical medicine, the same science courses MD's take, and a whole lot more neuropath, anatomy and neurochem. Take some time to research before you go to specialty forums and put down the profession. My guess is you are a HS grad thinking of going into medicine because your dad/mom both say so, and you are trying to justify it all. What do I know I am just a psychologist.........

cheers

 

[Pterion]

I can think of several things that show you are trolling, but that is another point. Your ignorance on this issue is showing. Regardless of your beliefs about RxP, most don't rattle on until they at least know that prescribing psychs take 1 year clinical medicine, the same science courses MD's take, and a whole lot more neuropath, anatomy and neurochem. Take some time to research before you go to specialty forums and put down the profession. My guess is you are a HS grad thinking of going into medicine because your dad/mom both say so, and you are trying to justify it all. What do I know I am just a psychologist.........

cheers

I've been clear in previous posts that I oppose RxP. I attended rounds last week with a lauded neurologist whose publications dance unabashedly into the territory of psychology (and occasionally into psychiatry). During a break, he was in a discussion with another physician who mentioned the issue of RxP. The speaker, to my great surprise, said "perhaps its because they realized what they do is placebo and want something science-based"

I was speechless. Sure, as a psychologist I was offended. As a medical student I was embarrassed by his disdain for other highly trained specialists. It did underscore a concern I have had that the well-attended battles for RxP have had an unfortunate side effect of eclipsing the important contribution that clinical psychology makes to healthcare and quality of life. Why does what we can already do get short shrift in the attempt to acquire what we don't really need?

I truly don't mean this to offend. I know there are strong feelings on both sides of the aisle. I am no more interested in convincing supporters they are wrong than I am of being recruited as a Baghdad street cleaner. But I want to point out that just because you can do a thing doesn't mean it should be done. Just because you know of others who do it poorly is an even worse reason.

 

[PsychEval]

I appreciate your post. I hope all of us within the field can recognize there is enough room in psychology for diverse interests. I’ve been clear in previous posts that I support RxP for appropriately trained psychologists. However, as we know, therapy certainly is not placebo. The mechanism of action of therapy may be unknown, just like the mechanism of action of many medications is unknown. I could easily attach 20 studies which suggests therapy is more effective than medication with a variety of conditions, but we all know this already. In your post, the physician you describe sounds like a clown. To my amusement, I see patients all the time with MDD, single episode, moderate who report GREAT IMPROVEMENT within 24 hours of taking Lexapro 10 mg. I’m sure there is no placebo going on there!

 

[Pterion]

In your post, the physician you describe sounds like a clown.

Yes. It was a disappointing moment, as I had previously appreciated his cross-disciplinary formulations.

To my amusement, I see patients all the time with MDD, single episode, moderate who report GREAT IMPROVEMENT within 24 hours of taking Lexapro 10 mg. I’m sure there is no placebo going on there!

Seeing it all the time...........

 

[PublicHealth]

I've been clear in previous posts that I oppose RxP. I attended rounds last week with a lauded neurologist whose publications dance unabashedly into the territory of psychology (and occasionally into psychiatry). During a break, he was in a discussion with another physician who mentioned the issue of RxP. The speaker, to my great surprise, said "perhaps its because they realized what they do is placebo and want something science-based"

The "lauded neurologist" needs to read more of his interdisciplinary literature:

http://www.journals.apa.org/prevention/volume1/pre0010002a.html