Oregon House Bill 2702 coming out of State Senate Committee for a full vote

[busi26]

This baloney about safe prescribing is getting old. Perhaps it is a case of Tourettes. There is no documentation of safe prescribing in La. and N.M.
None
Zero
Nada
Zip
Null, get it? This is an RxP fantasy.

I wonder why you two are avoiding my question.

"How many years of successful and safe prescribing by psychologists are needed for you to change your mind? Remember, psychologists have been prescribing in LA for over 5 years. Would you say that psychologists who have written thousands of scripts (with no adverse events) are not practicing safely?"

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[kugel]

I wonder why you two are avoiding my question.

"How many years of successful and safe prescribing by psychologists are needed for you to change your mind? Remember, psychologists have been prescribing in LA for over 5 years. Would you say that psychologists who have written thousands of scripts (with no adverse events) are not practicing safely?"

Well, then let's do a little math.
In residency, I generally saw 8-10 pts per day, avg 5.5 days per week.
8x5.5 = 44 pts per week for which I was prescribing or managing meds.

44 pts/week for 50 weeks per year = 2200 per year x 4 yrs = 8800
So that's a conservative estimate of 8800 visits per residency.
And that's clearly a LOW estimate, but let's use it.
Not all those visits involve a medication start/change/stop, but we consider it at EVERY visit, so I think those count.

If we had a new training system, you might reasonably consider it "experimental" until we had run, what, maybe, 200 residents through it?

8800 x 200 = 1,760,000 medication-related visits.
All under actual supervision of someone whose license and livelihood is directly on the line. Where the supervisor is required by billing reg's to "be present during critical parts of the exam" for EVERY visit billed (violations are prosecutable as fraud). And where any signif "mistakes" or bad outcomes are reported to another supervisor who has the certification and reputation of the entire training program on the line.

Anybody have equivalent data for prescribing psychologists who are permitted to prescribe most any psychotropic to anyone they want (i.e. much wider formulary than the DOD experiment)?
Does anybody have that kind of data with that kind of supervision available for even 20% of 1,760,000?

Or is the "data" we have from LA and NM simply that no deaths have been directly attributed to psychologists' prescribing and no prescribing psychologist has yet lost his/her prescribing license?

 

[whopper]

Be careful about feeding trolls....

 

[silas2642]

I wonder why you two are avoiding my question.

"How many years of successful and safe prescribing by psychologists are needed for you to change your mind? Remember, psychologists have been prescribing in LA for over 5 years. Would you say that psychologists who have written thousands of scripts (with no adverse events) are not practicing safely?"

But how do you know that there are no adverse events? Just because you don't know of any adverse events doesn't mean that they aren't occurring-- it seems like you're basically saying, "there aren't any reports of psychologists killing their patients yet with psychopharmatropics= proof that psychologists can safely and effectively prescribe meds," which is totally false. You have no idea whether or not PhD's are prescribing an acceptable regimen or how their patients are actually doing because no one has really studied it well.

Even straight-forward depression can get complicated if the patient has medical comorbodities-- what do you want to prescribe then? What do you need to monitor for? What physical conditions are they at risk for that could be masking as their psych sxs? It's so complicated and you guys are completely unaware of what you could be missing.

 

[stn2006]

I worked in ER where there is a prescribing psychologist nearby and so many of his patients came in with adverse affects from tremble due to lithium toxicity to increase in INR. Fortunately, where were reversible on time. The ER docs even wonder why so many psychiatrists in the areas but their patients rarely present with problem.

 

[Therapist4Chnge]

I worked in ER where there is a prescribing psychologist nearby and so many of his patients came in with adverse affects from tremble due to lithium toxicity to increase in INR. Fortunately, where were reversible on time. The ER docs even wonder why so many psychiatrists in the areas but their patients rarely present with problem.

I'm curious, what hospital?

 

[stn2006]

just listen to the news today. another drug company hide its data to push their own agenda.

 

[CGOPsych]

But how do you know that there are no adverse events? Just because you don't know of any adverse events doesn't mean that they aren't occurring-- it seems like you're basically saying, "there aren't any reports of psychologists killing their patients yet with psychopharmatropics= proof that psychologists can safely and effectively prescribe meds," which is totally false. You have no idea whether or not PhD's are prescribing an acceptable regimen or how their patients are actually doing because no one has really studied it well.

Even straight-forward depression can get complicated if the patient has medical comorbodities-- what do you want to prescribe then? What do you need to monitor for? What physical conditions are they at risk for that could be masking as their psych sxs? It's so complicated and you guys are completely unaware of what you could be missing.

Silas,
You are on the right track in my mind. Safe practice is an empirical question which can be answered, but is not simple. The RxPites don't want to study it empirically, they want a marketing slogan.

First, the question should be "if safety by pper's could be empirically supported, would that automatically make legislation to change our system of medical education and practice appropriate and necessary? The answer of course is no. Changes in the system have many costs and risks, and it is incumbent upon those who propose it to show that the change is necessary, has no better alternative, is safe and is effective.

The RxPites of course haven't even come close to showing evidence for any of this. They cling to the "safe prescribing" mantra as if they were selling breakfast cereal to children.

The RxPites have had many years to empirically study safety, even though that is only one issue, and they have done nothing about it. Zero, zilch, nada, etc. Instead they crank out the marketing slogans which they cannot support.

Once again, this is not about professionalism or patient care. It's a political/marketing campaign designed to maximize profits and political power. As such the RxPites will only troll on the message boards and avoid open debate whenever possible.

 

[kugel]

On 2/129/10, Busi26 wrote:
"How many years of successful and safe prescribing by psychologists are needed for you to change your mind?"

8800 x 200 = 1,760,000 medication-related visits.
All under actual supervision of someone whose license and livelihood is directly on the line. Where the supervisor is required by billing reg's to "be present during critical parts of the exam" for EVERY visit billed (violations are prosecutable as fraud). And where any signif "mistakes" or bad outcomes are reported to another supervisor who has the certification and reputation of the entire training program on the line.

Anybody have equivalent data for prescribing psychologists who are permitted to prescribe most any psychotropic to anyone they want (i.e. much wider formulary than the DOD experiment)?
Does anybody have that kind of data with that kind of supervision available for even 20% of 1,760,000?

Okay, how about 2%?
Do we have data on outcomes of 35,200 visits supervised by a licensed, prescribing board-certified expert who actually saw the pt face-to-face?

Anyone....?
Bueller....?
http://www.youtube.com/watch?v=f4zyjLyBp64

 

[whopper]

I'm going to start a movement where people can fly planes if they play Microsoft Flight Simulator.

What will it take for you people to finally become convinced that if you can play Flight Simulator, you can fly a real plane? What will it take!?!?

If you don't jump on the bandwagon, I guess it's, ahem....sour grapes.

OK now I'm not commenting on this thread anymore.

 

[st2205]

These programs need to be opened up to MSWs and possibly BSWs, as well, to make sure that psych meds are able to be given to all those that can't get access, and since there really isn't a whole lot of difference between MSW and psych PhD with regard to prerequisites for the program. Surely both could be trained side-by-side effectively.

 

[Therapist4Chnge]

I'm going to start a movement where people can fly planes if they play Microsoft Flight Simulator.

What will it take for you people to finally become convinced that if you can play Flight Simulator, you can fly a real plane? What will it take!?!?

If this wasn't true, everyone would have died in "Snakes On A Plane" because the guy wouldn't have been able to land the plane!!

 

[CGOPsych]

These programs need to be opened up to MSWs and possibly BSWs, as well, to make sure that psych meds are able to be given to all those that can't get access, and since there really isn't a whole lot of different between MSW and psych PhD with regard to prerequisites for the program. Surely both could be trained side-by-side effectively.

LOL, you put your finger on another aspect of the shameless greed of the RxPers. When you get them to answer that question they say this:

Even though psychologists have NO prior biological training before taking their medical education in correspondence school, social workers who are also licensed to practice psychotherapy independently are so undertrained that they couldn't possibly be adequately trained to prescribe.

It almost becomes Orwellian. Hey, these online programs as so fantastic that we who have no experience in the medical system or any prior education can become prescribers, but they're not so fantastic that social workers can learn to do it.

Yeah, right. My friends, it's about greed and the lust for political power. It is NOT about helping our patients. The hypocritical shamelessness of it all is what does get me irritated at times.

 

[kugel]

On 2/129/10, Busi26 wrote:
"How many years of successful and safe prescribing by psychologists are needed for you to change your mind?"



Okay, how about 2%?
Do we have data on outcomes of 35,200 visits supervised by a licensed, prescribing board-certified expert who actually saw the pt face-to-face?

Anyone....?
Bueller....?
http://www.youtube.com/watch?v=f4zyjLyBp64

Okay then, we apparently have NO DATA on safe prescribing practices by RxP under the direct supervision of a MORE qualified "expert" who has seen the pt face-to-face. Unless RxPers show they have this kind of data - I'll have to assume that it does not exist.

Any future claims of data of safe prescribing can be immediately debunked with the phrase:
When you have 1,760,000 visits under direct supervision of a board certified psychiatrist, please show it to me.

Any claims that the vast majority of psychologists favor this move can be debunked with the phrase:
Please show me the raw data from your polling.

Any claim that psychologists who get RxP license tend to live in rural areas or will move there, can be debunked with a request for the list of RxP Psychologists who live more than 60 miles outside of a city of >200k people. Edeib's list showed 4.

FIN!

 

[CGOPsych]

I wonder why you two are avoiding my question.

"How many years of successful and safe prescribing by psychologists are needed for you to change your mind? Remember, psychologists have been prescribing in LA for over 5 years. Would you say that psychologists who have written thousands of scripts (with no adverse events) are not practicing safely?"

Busi26: I have just learned something even more disturbing about you RxPers. I have learned that for all this time, in Louisiana there was a "concurrence clause" in the law which required prescribing psychologists to not only consult with a patient's physician, but to obtain that doctor's concurrence before writing a prescription.

This completely neutralizes any claims of safe prescribing. After all, your average counter help at McDonald's could "safely prescribe" if they had to call patients' physicians and get them to agree with each prescription. You not only have no safety data, from Louisiana you couldn't have any. It would be worthless.

So now my question is: Were you ignorant of this and just blindly repeating this grossly misleading piece of propaganda or were you indeed aware of it?

I think you and the other RxPers owe us an answer here.

 

[busi26]

Okay then, we apparently have NO DATA on safe prescribing practices by RxP under the direct supervision of a MORE qualified "expert" who has seen the pt face-to-face. Unless RxPers show they have this kind of data - I'll have to assume that it does not exist.

Any future claims of data of safe prescribing can be immediately debunked with the phrase:
When you have 1,760,000 visits under direct supervision of a board certified psychiatrist, please show it to me.

Any claims that the vast majority of psychologists favor this move can be debunked with the phrase:
Please show me the raw data from your polling.

Any claim that psychologists who get RxP license tend to live in rural areas or will move there, can be debunked with a request for the list of RxP Psychologists who live more than 60 miles outside of a city of >200k people. Edeib's list showed 4.

FIN!

Sounds like sour grapes to me. So how many years of psycholigists safely prescribing psychotropics will it take to change your minds?

Would none of you ever visit an optimetrist? NP? Podiatrist? The same "dangers" were cited before, during, and shortly after these professionals fought for the right to prescribe meds. After the laws were signed, the public found out that the fearmongers were just trying to protect their turf!

 

[sideways]

Sounds like sour grapes to me. So how many years of psycholigists safely prescribing psychotropics will it take to change your minds?

Would none of you ever visit an optimetrist? NP? Podiatrist? The same "dangers" were cited before, during, and shortly after these professionals fought for the right to prescribe meds. After the laws were signed, the public found out that the fearmongers were just trying to protect their turf!

busi, if you want to play doctor, just go to medical school. I know all that medicine you learn in medical school is irrelevant, but at least people won't be questioning your qualifications any longer.

 

[kugel]

So how many years of psycholigists safely prescribing psychotropics will it take to change your minds? !

My answer is (as stated a few days ago):
the equivalent of running 200 residents through a new type of residency training program: 1,760,000 medication-related visits.
Why would any new prescription training program collect less data than that?

Wouldn't you want a new pilot training program to collect data from at least as many supervised flights as the current training program before declaring it as anything other than "experimental?"

So, in reference to the other question raised above,
How exactly DOES it operate in LA where RxPers have to call an MD and gain approval for each Rx written? Does that happen during the office visit? Does it happen after? If after, how does one change the Rx if the MD disagrees? Does the MD keep a record of these consultations?

Who is policing this to assure that all RxP prescriptions are actually agreed to by an MD?

 

[st2205]

Sounds like sour grapes to me. So how many years of psycholigists safely prescribing psychotropics will it take to change your minds?

Would none of you ever visit an optimetrist? NP? Podiatrist? The same "dangers" were cited before, during, and shortly after these professionals fought for the right to prescribe meds. After the laws were signed, the public found out that the fearmongers were just trying to protect their turf!

Without fearmongering, what would you say to opening up the programs to MSWs?

 

[kugel]

Without fearmongering, what would you say to opening up the programs to MSWs?

How about PharmD's?
PharmD's have a tremendous background in clinical medicine, chemistry, physiology, and (obviously) pharmacology. In some situations, they are already permitted to make certain medication changes, order labs, etc.

 

[CGOPsych]

Sounds like sour grapes to me. So how many years of psycholigists safely prescribing psychotropics will it take to change your minds?

Would none of you ever visit an optimetrist? NP? Podiatrist? The same "dangers" were cited before, during, and shortly after these professionals fought for the right to prescribe meds. After the laws were signed, the public found out that the fearmongers were just trying to protect their turf!

I see you have not responded to my message about your "safety data" in Louisiana. I think you owe us all an explanation.

 

[st2205]

How about PharmD's?
PharmD's have a tremendous background in clinical medicine, chemistry, physiology, and (obviously) pharmacology. In some situations, they are already permitted to make certain medication changes, order labs, etc.

I think this is much more legitimate.

 

[busi26]

busi, if you want to play doctor, just go to medical school. I know all that medicine you learn in medical school is irrelevant, but at least people won't be questioning your qualifications any longer.

Go to med school to prescribe psychotropics? I think we can all agree that isn't necessary. At least in NM, LA, Guam, the military. And soon to be in OR and Missouri.

Interesting that no one touched my last statement about NPs, Optometrists, or podiatrists...

 

[OldPsychDoc]

How about PharmD's?
PharmD's have a tremendous background in clinical medicine, chemistry, physiology, and (obviously) pharmacology. In some situations, they are already permitted to make certain medication changes, order labs, etc.

Yet PharmD's rarely talk to a patient or take a history, and never examine a patient! One might argue that these are prerequisites to safe prescribing.

 

[Abacab]

Go to med school to prescribe psychotropics? I think we can all agree that isn't necessary. At least in NM, LA, Guam, the military. And soon to be in OR and Missouri.

Interesting that no one touched my last statement about NPs, Optometrists, or podiatrists...

You are an ignorant fool. How could YOU possibly know what is necessary to safely and carefully prescribe psychotropics?

Okay, I'll touch on your last statement. Would I go to an NP? No, I choose to see physicians for my medical needs.
Do I go to optometrists? Sure I do. I get my eyeglasses Rx'ed by one every couple of years. I really like my optometrist too. Had him since I was a kid. If I ever have an problems with my eyes other than myopia, I'll seek the services of an opthalmologist, however.
Podiatrist, sure I'd see one if I had problems with my feet. I have family members who use their services.

However, I fail to see any comparisons. You see, all of the mid-level provider careers require medical training, some of which is pretty extensive. Optometrists actually go to school for four years where they are highly focused on the eyes from the get-go. Podiatrists know far more about feet than most primary docs.
Psychologists do not undergo any medical training. Have you even once auscultated for murmurs? As far as I know, you don't even have to take a basic molecular biology or anatomy course to become a psychologist. What makes you think that all those years of schooling and training that we endure can be circumvented and still result in a competent medical practitioner? That is, after all, what you are trying to become. A medical practitioner...but one without any degree in medicine. Absurd.

This, to me, is the same as those "life coaches" who have no training in psychology but try to pass as them and provide "counseling/therapy."

Psychologists are highly educated and have my professional respect. However, they would be no better off prescribing than someone with an MBA or a JD...or heck, even my mechanic. They all have one thing in common....the same level of medical training....zero.

Say what you want busi, but if you ever have a child with a serious medical/mental health problem, I'd bet money that you'd be seeking the services of a physician/psychiatrist over a psychologist/NP.

 

[edieb]

You are an ignorant fool. How could YOU possibly know what is necessary to safely and carefully prescribe psychotropics?

Okay, I'll touch on your last statement. Would I go to an NP? No, I choose to see physicians for my medical needs.
Do I go to optometrists? Sure I do. I get my eyeglasses Rx'ed by one every couple of years. I really like my optometrist too. Had him since I was a kid. If I ever have an problems with my eyes other than myopia, I'll seek the services of an opthalmologist, however.
Podiatrist, sure I'd see one if I had problems with my feet. I have family members who use their services.

However, I fail to see any comparisons. You see, all of the mid-level provider careers require medical training, some of which is pretty extensive. Optometrists actually go to school for four years where they are highly focused on the eyes from the get-go. Podiatrists know far more about feet than most primary docs.
Psychologists do not undergo any medical training. Have you even once auscultated for murmurs? As far as I know, you don't even have to take a basic molecular biology or anatomy course to become a psychologist. What makes you think that all those years of schooling and training that we endure can be circumvented and still result in a competent medical practitioner? That is, after all, what you are trying to become. A medical practitioner...but one without any degree in medicine. Absurd.

This, to me, is the same as those "life coaches" who have no training in psychology but try to pass as them and provide "counseling/therapy."

Psychologists are highly educated and have my professional respect. However, they would be no better off prescribing than someone with an MBA or a JD...or heck, even my mechanic. They all have one thing in common....the same level of medical training....zero.

Say what you want busi, but if you ever have a child with a serious medical/mental health problem, I'd bet money that you'd be seeking the services of a physician/psychiatrist over a psychologist/NP.

I don't think you can say psychiatrist > psychologist. For example, I think many consumers would seek the opinion of a university-educated psychologist (i.e., not one from a professional school) before seeking help from a psychiatrist graduating from a Caribbean or other sub-par medical school. If you were talking about a psychologist versus a psychiatrist, both of whom graduated from respected schools, I think whose advice one would seek would be contingent on the referral question needing to be answered.

Study after study has demonstrated that ebts outperform medications for many disorders. Furthermore, research has shown a diathesis-stress model in operation for many disorders in which medications are always necessary (scz, bipolar disorder). However, best practice protocols also recommend psychological treatment to potentiate medication regimens.

I will say this about psychology: Although there are many effective interventions available, most mental health providers fail to provide these treatments. If you are to believe a study that just came out of Yale, most (something like 99 percent) of psychologists who claim to be c-b in orientation, fail to actually practice much CBT, and, out of the ones who do actually practice CBT, almost all of them fail to provide CBT at a level advanced enough.

Thus, as psychologists, we really need to ensure that we receive more intensive training in therapy and make sure that learning how-to prescribe meds only takes place after individuals master the art of therapy. I think that psychologists who wish to prescribe meds should have to demonstrate mastery of therapy in some way....

 

[kugel]

Yet PharmD's rarely talk to a patient or take a history, and never examine a patient! One might argue that these are prerequisites to safe prescribing.

I agree completely with your point.
It was, indeed, a straw man argument:
Since PharmD's have all the chemistry and pharmacology training, they should be safe prescribers with maybe just a one-weekend course in psychology?!


I got to work with a PharmD who did all those things as a colleague in a "psychiatry/primary care clinic" and the collaboration was Great for me and for the patients. Now, she happened to believe enough in the need to have MORE clinical training that she went on to become a PA - and was then even better for our patients. After the 4th or 5th time she told me, "Don't worry about the laboratory monitoring of the meds. I'll take care of that and fwd the results to you with recommendations. YOU just focus on the pt's complaints and his improving his life," I finally let her do that.

 

[busi26]

I don't think you can say psychiatrist > psychologist. For example, I think many consumers would seek the opinion of a university-educated psychologist (i.e., not one from a professional school) before seeking help from a psychiatrist graduating from a Caribbean or other sub-par medical school. If you were talking about a psychologist versus a psychiatrist, both of whom graduated from respected schools, I think whose advice one would seek would be contingent on the referral question needing to be answered.

Study after study has demonstrated that ebts outperform medications for many disorders. Furthermore, research has shown a diathesis-stress model in operation for many disorders in which medications are always necessary (scz, bipolar disorder). However, best practice protocols also recommend psychological treatment to potentiate medication regimens.

I will say this about psychology: Although there are many effective interventions available, most mental health providers fail to provide these treatments. If you are to believe a study that just came out of Yale, most (something like 99 percent) of psychologists who claim to be c-b in orientation, fail to actually practice much CBT, and, out of the ones who do actually practice CBT, almost all of them fail to provide CBT at a level advanced enough.

Thus, as psychologists, we really need to ensure that we receive more intensive training in therapy and make sure that learning how-to prescribe meds only takes place after individuals master the art of therapy. I think that psychologists who wish to prescribe meds should have to demonstrate mastery of therapy in some way....

Great points! A psychologist's tool bag is filled primarily with empirically supported treatments. Prescription privileges will be a nice supplement to the toolbag, but will not be the sole tool used. The two years of intensive training in psychopharmacology ensures that these prescribers are able to safely combine psychotherapy with psychotropics.

 

[st2205]

Great points! A psychologist's tool bag is filled primarily with empirically supported treatments. Prescription privileges will be a nice supplement to the toolbag, but will not be the sole tool used. The two years of intensive training in psychopharmacology ensures that these prescribers are able to safely combine psychotherapy with psychotropics.

Can MSWs enter the program and effectively add that tool to their bag, so that more care can be provided? Is this a possibility?

 

[whopper]

I don't think you can say psychiatrist > psychologist. For example, I think many consumers would seek the opinion of a university-educated psychologist (i.e., not one from a professional school) before seeking help from a psychiatrist graduating from a Caribbean or other sub-par medical school.

1) The most likely person people seek for mental health problems are their PCPs--whatever school that person graduated from over a psychiatrist or psychologist.
2) The next most utilized person is a psychiatrist.

My comments are evidenced-based. The data was taken from National Comorbidity Survey and Epidemiological Catchment studies which are considered landmark studies in both psychology and psychiatry.

You brought this issue up before, and I showed you direct links to the studies a few months ago. Since I already did that, and I have limited time, I will not do so again.

And that's not to say seeking a PCP first is right or seeking a psychologist first is wrong. There's no problem in seeking a psychologist first if someone has a mental health concern. I'm merely pointing this out because you brought this issue before. Further you have several times in the past seemingly attempted to push both psychiatrists and psychologists into an us vs. them argument. We are both supposed to be helping people, not lock horns in a battle against each other. If that is not your intent, then I apologize.

I personally don't think a psychiatrist is necesarily better than a psychologist. Both have expertise in mental health, though the training is different, with different focuses. I can certainly think of several psychologists I'd rather have on my team than several psychiatrists, and IMHO in several patients really do need psychotherapy and may not even be appropriate for psychotropic treatment.

The two years of intensive training in psychopharmacology ensures that these prescribers are able to safely combine psychotherapy with psychotropics.

Again, the non-medically trained making judgment on what is acceptable medical training and with no evidenced-based data to back your claims. I'm not debating you. I'm finished with that.

Oh by the way, Flight Simulator! We need to pass a law that allows Microsoft to give people pilot's licenses if they can play that game. Oh by the way I have no expertise or training whatsoever in being able to fly a plane other than playing some Sega Afterburner, some flight simulators and being a passenger. Don't agree---Sour grapes!

 

[CGOPsych]

Great points! A psychologist's tool bag is filled primarily with empirically supported treatments. Prescription privileges will be a nice supplement to the toolbag, but will not be the sole tool used. The two years of intensive training in psychopharmacology ensures that these prescribers are able to safely combine psychotherapy with psychotropics.

You owe us an explanation of your reckless use of the "safety data" mantra in light of the concurrence clause in Louisiana.

 

[Abacab]

I don't think you can say psychiatrist > psychologist. For example, I think many consumers would seek the opinion of a university-educated psychologist (i.e., not one from a professional school) before seeking help from a psychiatrist graduating from a Caribbean or other sub-par medical school. If you were talking about a psychologist versus a psychiatrist, both of whom graduated from respected schools, I think whose advice one would seek would be contingent on the referral question needing to be answered.

You are misinterpreting my statement. Please read my prior comments carefully. Nowhere did I say psychiatrist>psychologist. My opinion, as a medical professional, is that the science of prescribing medication is best left to medical professionals, not psychologists.

Frankly, it tires me when non-medical mental health professionals posture as if they know anything about medicine...especially when they claim to know what is considered adequate training in medicine.

Let me say this again, if you have family member/loved one with a serious medical/mental health problem that requires medication, you'll be seeking out a psychiatrist/physician over a NP/psychologist/insert any mid-level provider here, if you have any choice in the matter.

 

[CGOPsych]

I don't think you can say psychiatrist > psychologist. For example, I think many consumers would seek the opinion of a university-educated psychologist (i.e., not one from a professional school) before seeking help from a psychiatrist graduating from a Caribbean or other sub-par medical school. If you were talking about a psychologist versus a psychiatrist, both of whom graduated from respected schools, I think whose advice one would seek would be contingent on the referral question needing to be answered.

Study after study has demonstrated that ebts outperform medications for many disorders. Furthermore, research has shown a diathesis-stress model in operation for many disorders in which medications are always necessary (scz, bipolar disorder). However, best practice protocols also recommend psychological treatment to potentiate medication regimens.

I will say this about psychology: Although there are many effective interventions available, most mental health providers fail to provide these treatments. If you are to believe a study that just came out of Yale, most (something like 99 percent) of psychologists who claim to be c-b in orientation, fail to actually practice much CBT, and, out of the ones who do actually practice CBT, almost all of them fail to provide CBT at a level advanced enough.

Thus, as psychologists, we really need to ensure that we receive more intensive training in therapy and make sure that learning how-to prescribe meds only takes place after individuals master the art of therapy. I think that psychologists who wish to prescribe meds should have to demonstrate mastery of therapy in some way....

You owe us an explanation for your reckless and misleading statements about psychologists prescribing safely. Are you woefully ignorant of the facts or were you intentionally misleading your health care colleagues repeatedly?

 

[maranatha]

I will say this about psychology: Although there are many effective interventions available, most mental health providers fail to provide these treatments. If you are to believe a study that just came out of Yale, most (something like 99 percent) of psychologists who claim to be c-b in orientation, fail to actually practice much CBT, and, out of the ones who do actually practice CBT, almost all of them fail to provide CBT at a level advanced enough.

Thus, as psychologists, we really need to ensure that we receive more intensive training in therapy and make sure that learning how-to prescribe meds only takes place after individuals master the art of therapy. I think that psychologists who wish to prescribe meds should have to demonstrate mastery of therapy in some way....

Your statements beg the question, why would psychologists who don't even follow EBT in their own area of expertise be expected to follow evidence-based medical practices?

Maybe you should put more energy into making sure psychologists are following the evidence based treatments that they are supposed to be experts at before introducing an entire new therapy that takes years and years of training to become proficient at?

 

[Therapist4Chnge]

Your statements beg the question, why would psychologists who don't even follow EBT in their own area of expertise be expected to follow evidence-based medical practices?

Maybe you should put more energy into making sure psychologists are following the evidence based treatments that they are supposed to be experts at before introducing an entire new therapy that takes years and years of training to become proficient at?

I'm glad you aren't generalizing..... It is akin to saying because there are some psychiatrists that start writing a prescription before the person walks through the door, that must be how every psychiatrist chooses to practice. Or since some psychiatrists choose to sell out to Big Pharma, that all psychiatrists are willing to sell their professional opinions for a few good dinners and questionable "speaking" fees.

 

[kugel]

I'm glad you aren't generalizing..... It is akin to saying because there are some psychiatrists that start writing a prescription before the person walks through the door, that must be how every psychiatrist chooses to practice. Or since some psychiatrists choose to sell out to Big Pharma, that all psychiatrists are willing to sell their professional opinions for a few good dinners and questionable "speaking" fees.

No question. You're right about that. The "one bad apple" argument never works really well, and it will get turned back on you.

But before it's all done, can I get ONE good dinner? Please. Someone?

 

[edieb]

Well, the RxP bill passed the Oregon Senate tonight, Feb 22nd.

 

[whopper]

I just read an article on it.

http://www.oregonlive.com/politics/index.ssf/2010/02/senate_narrowly_passes_bill_th.html

"I do support the concept of psychologists prescribing in a limited way with oversight from the Oregon Medical Board," he said, adding that state law should require not just collaboration but supervision by a physician.

Actually, I don't mind the issue so much if a physician has oversight on it and the psychologist is offering recommendations for medications while not actually being the prescriber, while the physician oversees the possible medical side effects, whether or not that physician is a psychiatrist.

There's a difference though, the prescriber should be a physician, not a psychologist. It only makes sense since it would be the physician who's responsible for the medical aspects of it and has the medical training.

I don't know if the proposed bill made any changes since the last time I read it. I don't know if any later changes required physician supervision, but if it did, it pretty much nulls and voids the need for a psychologist to prescribe because then the physician could do it.

 

[HMSPSYCH]

I don't think you can say psychiatrist > psychologist. For example, I think many consumers would seek the opinion of a university-educated psychologist (i.e., not one from a professional school) before seeking help from a psychiatrist graduating from a Caribbean or other sub-par medical school. If you were talking about a psychologist versus a psychiatrist, both of whom graduated from respected schools, I think whose advice one would seek would be contingent on the referral question needing to be answered."

I wonder if you truly know what medical training really entails. Many would consider I attended a second rate, or 'sub par' medical school in the hinterland. After receiving my medical degree (and studying/passing grueling day long exams), I continued my training as a resident and fellow at arguably one the top medical school in the country. After nine years of medical training to I can confidently say what I learned as a resident and fellow far exceeded what I learned as a medical student. And I am still learning as an junior attending. To know truly how various disease states can mimic mental illenss, how mental illness affect the rest of the body, how psychotropics/brain can affect the rest of the body and vice versa take much longer than the 2 years required these RxP bills currently require. I fear for the patients more than anyone else if more poorly trained clinicans are allowed to prescribe these difficult and unpredictable medications. Prescribing psychotropics is very difficult but may look easy to the untrained. During my training, I encountered more than a few cases when patients were admitted on my shift due to poorly monitored medications adverse side effects prescribed by NPs or busy PCPs. More often than not, these patients were transferred from the medical floors including the ICU.

 

[whopper]

I just read the latest draft of the bill that was available online.

http://www.leg.state.or.us/bills_laws/concepts/sen/SB1046.pdf

I'm still against it, though it's a better bill than the one I read months ago. It does require a medical professional as designated by the Ohio Medical Board to be part of a collaboration with the psychologist-prescriber.

That's better.

But I still got several problems with it.

The psychologist is still the prescriber. What if the 2 in the party disagree? I can think of several situations where that can happen and since the psychologist is the prescriber, the medication can still go through. This brings up several legal problems. E.g. what if the psychologist prescribes against the recommendation of the M.D. or D.O., there's a bad outcome? Who then is medically responsible? I didn't see much data there.

Does that happen in real life? Yes. I've had disagreements with several other M.D.s and psychologists on the treatment of my patients. I can list several examples but in the end, legally, the way the laws and our responsibilities were, it left a much clearer direction of who'd be responsible if there was a bad outcome.

IMHO what should happen, and this would be very acceptable to me for an existing practitioner who can prescribe as the final authority, while the psychologist can offer recommendations for psychotropic medication in a general sense, not a very specific sense. E.g. the person is depressed, they could recommend an SSRI. The M.D. or D.O. can take the recommendation or not of the psychologist since ultimately there will be a large grey area as to the responsibility of the medical issues. E.g. if the person is on Paxil, gains weight and get's diabetes, who's responsible?

Why general? Well the medical training is not very extensive in comparison to what M.D.s have to go through. Several non-psychotropic medications for non psychiatric disorders can cause problems if mixed with psychotropic meds. Just one example is hyperammonemia caused by topamax mixed with Depakote. That's just one out of thousands. Lithium and motrin also have a problem when mixed. Or how about an SSRI in someone with a bleeding disorder? In all the cases, the problems could lead to fatal outcomes. The suggestion must be generalized because there could be medical issues that clearly indicate a suggested medication should not be given that a psychologist-prescriber could miss, and then if there's a bad outcome who's responsible?

Is it inconvenient? IMHO no more than the Oregon bill. That bill still requires a collaboration. A medical doctor could simply call up the pharmacy at the end of the day after the psychologist prescriber gave a recommendation and the medical doctor reviews the case without having to see the patient unless the medical doctor wants to see the patient again over the issue--which would've happened anyway in the Oregon bill.

In terms of convenience, my idea is very similar to the bill. There's still a required collaboration, but what's different is the medical professional has the training and ultimately it's their responsibility for the medical consequences. That clears up a lot of problems that the bill can bring up.

 

[busi26]

It seems that the Oregon Senate has listened to reason and passed the bill allowing properly trained psychologists to prescribe psychotropic medications. Thank goodness that the Oregon senate didn't listen to the fearmongering turf-protecting opposition. Kudos! The vote was 18-11 - nearly 2 to 1.

Did you see the report about the Virgin Islands sending an RxP bill to the senate? Here is the article. http://behavioralhealthcentral.com/index.php/20100216202781/Latest-News/bill-to-let-psychologists-prescribe-medications-goes-before-senators-the-virgin-islands-daily-news-st-thomas.html

 

[busi26]

Again, the non-medically trained making judgment on what is acceptable medical training and with no evidenced-based data to back your claims. I'm not debating you. I'm finished with that.

We agree that I have provided more "safety data" about psychologists prescribing than you have provided about psychiatrists prescribing.

 

[maranatha]

I'm glad you aren't generalizing..... It is akin to saying because there are some psychiatrists that start writing a prescription before the person walks through the door, that must be how every psychiatrist chooses to practice. Or since some psychiatrists choose to sell out to Big Pharma, that all psychiatrists are willing to sell their professional opinions for a few good dinners and questionable "speaking" fees.

Of course. It goes without saying that this study doesn't speak for the entire field.

I was only trying to give a suggestion for a more productive outlet to direct his or her energy...

 

[whopper]

We agree that I have provided more "safety data" about psychologists prescribing than you have provided about psychiatrists prescribing.

No we don't.

You offer political talking points. I didn't provide data because the request IMHO was on the order of asking me if the sky is blue. There's already plenty of "safety data." The overwhelming majority (and when I say that I don't mean 75%--far far more than that) of studies ever published where medication safety and efficacy were measured were given to people by physicians. There's already plenty of data out there concerning physician training and successful outcomes.

The answer was so blatantly out there I didn't answer you, and only reveals how little you know about the safety of medical practice.

Again it's akin to someone asking if the sky was blue, or if 1 + 1 = 2, that is if you actually had medical training and know what you were talking about---which apparently you don't.

If someone debates me and questions whether 1 + 1 =2, I'm not even going to entertain the argument.

I try not to be so pointed, but from your posts, you don't seem to know what evidenced-based data is. You do though seem to understand slogans and political talking points.

Actually I'm actually starting to wonder if you're a psychologist and not a drug-rep or just a troll because you seem so ill-informed about evidenced based data.

And by the way, you didn't even cite the DOD study until I mentioned it first. That was the only study ever done on this issue, and it didn't even advocate for psychologist-prescribers in the general public. So if anyone's brought up real evidenced-based safety data of psychologists-it's me, and like I said the data was somewhere between mildly-cold to lukewarm.

 

[billypilgrim37]

But whopper, you didn't address the font he used throughout his posts. Obviously, since he can use the same font that physicians and medical students use, he should also be able to prescribe psychotropics. Your silence on this matter shows that you are a coward who hides behind your turf and lobs reimbursement water balloons at the head of the public you swore to serve. You heartless punk, how dare the Great Whopper bother to sniff the jock strap of the all-around superior prescribing psychologist! For shame, sir! Have you no sense of decency?!

 

[whopper]

Hey, like I said, Microsoft Flight Simulator.

A post from Busi26 in another thread...

News Flash. I am a clinical psychologist and I took Chemistry, Organic, Biology (multiple courses), Anatomy and physiology (1 and 2), and many other courses that "premed" students take. Thus, your premise that psychologists have no background in the "hard" sciences is faulty.

Most psychologists don't take the above courses unless they went for a B.S. or were pre-med.

Trying to be as nice as possible to Busi26, I don't think he or she actually gets the logic.

E.g. if one psychologist took pre-med courses it does not mean all of them, or even a significant amount took them, yet Busi26 advocates for this.

I'm wondering if Busi26 is actually even understanding the counter points we've brought up here and is really only seeing this in emotionalistic black and white terms. For or against the issue. If you're against, you're against--no consideration to the evidence and no willingness to speak of it other than political talking points, use of histrionic terms instead of reason such as "fear-mongering" and "the great Whopper."

Either that or Busi26 is a troll or someone else with an agenda other than to actually debate this for real.

So if Busi26 is actually for real--a clinical psychologist, he or she doesn't actually appear to be able to take in the counter-points, and then retorts back with a comment that actually doesn't make any evidenced-based logic.

 

[billypilgrim37]

But where is your data that real pilots can fly planes safely? Gotcha again!

btw, 2+2=5 is the first track of an excellent album.

 

[whopper]

It's interesting because out of curiosity I've checked Busi26's other posts because I was thinking perhaps this person was not a psycholgist. But this person did mention some work with psychology.

and I find it even more ironic that this person in other posts debated others and demanded data...

What are you citing? I would appreciate a recent citation.

But when asked, could not provide anything other than the DOD study that like I said, if you actually read it really doesn't advocate for psychologist-prescribers.

And as I said before, I do think a psycholgist could be involved in psychotropic meds under certain circumstances. The psychologist for example could get an M.D., go through residency or in the case of Oregon, the medical doctor would be the ultimate prescriber while working with a psychologist, or the psycholgists could go through more extensive medical training. I would advocate for psychologists prescribers if their training was more extensive than that in the Oregon bill.

But then again, I don't think the debate here, if you can call it that was evidenced based. It was more about political talking points. Several of us (especially CGOpsyche) tried to make this evidenced-based.

By the way, I've read Therapist4change's posts on this issue in the psychology thread. T4C wants psychologist prescription power but he (or she, sorry I don't know your gender) wants it to be done with the appropriate medical training, and T4C has been willing to debate the issue following actual accepted rules of debate.

You can't argue with someone who isn't even listening or responding to your input to the debate.

 

[billypilgrim37]

I notice how you avoid my question about data showing that pilots can fly planes safely. You must be hiding behind your "logic." Did you know that "logic" and "lies" both start with the letter L?

Ok, I'm going to stop now. Maybe. You're making it too easy for me, Big W.

 

[Therapist4Chnge]

By the way, I've read Therapist4change's posts on this issue in the psychology thread. T4C wants psychologist prescription power but he (or she, sorry I don't know your gender) wants it to be done with the appropriate medical training, and T4C has been willing to debate the issue following actual accepted rules of debate.

You can't argue with someone who isn't even listening or responding to your input to the debate.

He...and yes, I think the training needs to be improved, particularly the deliver of the education and the hour requirements for the "residency" portion. I think where RxP support really hits a snag is with the issue of autonomy. A collaborative agreement where the prescribing psychologist is able to consult as needed with cases not only leverages both professional's abilities, but it also addresses a major concern raised by people who oppose RxP rights for psychologists.