Perceptions

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Psyclops

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  1. Other Health Professions Student
So, as I would think most here know, there is a forum for psychiatry and a seperate forum for clinical psychology. Naturally there would be, they are different degrees. Also, you may have noticed (for those who visit both) that the psychiatry forum is much more active. Now, as some also might have noticed, the psychiatry forum has been visited by quite a few more frustrated past patients than the phd/psyd board. I can hear some of you saying "Get to the point counselor." and I assure you I will. So, the psychiatrists who practice do both psychopharm and therapy (theoretcially) and many also work both inpt. and outpt. where as fewer psychologists work inpt. and almost none do pharm. The question is: Do you think it is the psychopharm, or inpt work, or the fact that the board is more active, or some other aspect that leads frustrated patients to come here and vent as opposed to the psychology forum? And furthermore, out in the real world, do you think people tend to be more frustrated by psychiatrists than psychologists?
 
I think there's plenty for psychiatric patients to be frustrated with, and, psychiatric patients tend to have more Axis II problems, putting them in a demographic where these people complain more so.

I have a bachelor's in psychology, and I'm frustrated by the lack of psychological training that is going on in psychiatry these days.

Yes I realize that they are 2 different fields, but the APA, the college of psychiatry, and heck our patients expect us to know psychology. Given this, they ought to be teaching it more, but most programs seem to simply focus on the psychopharm aspects.

I don't know the exact reason why there's more activity on this board, but most MD's and aspiring MD's will gravitate to psychiatry more so than psychology. This site is designed for MDs, not psychologists in general.
 
Just as a PS to my previous post, I didn't intend fo rthis to be a bashing session of either ology or iatry. Just a ? about is thre some aspect that you think the average patient might find frustrating. 🙂
 
Sorry...yeah some of the post was a rant.
Sorry, yeah some of the post was a rant, and of course there's plenty of DOs on the board as well.

I figure that a clinical psychology student/practitioner might go to a more specialized board just for them. The site appears to be geared towards MD/DOs.

Are patients more or less happy with psychiatrists vs psychologists. I have no idea. I'd imagine they'd dislike their psychiatrists more because psychiatrists often treat patients on an involuntary basis and committed patients often have psychopathology to a degree much worse than what I'd expect to see in psychological patients.

Some of my own perception of this may be wrong, but I have the idea that the majority of psychological patients are not committable, and thus are seeing their psychologist-therapists on a voluntary basis and thus want treatment.
 
I think that is a good point. When I used to work inpatient I would sit a dream about patients who were in the least bit motivated for treatment. They say they are out there.....
 
Could it be that physicians in general have become a target of blame in society? Before we were heralded as pillars of the community and respected for our devotion and dedication to the art. Now as we are even more capable and our education much richer, we are (not necessarily generally) disrespected and not completely trusted. I think that there is an authority opposition that was not present earlier. And as physicians we are authourity figures within the realm of medicine and health. Now we are targeted for LAWSUITS and therefore defamed in the media as a result of the sensationalistic voyeur America, because "we are incompetent, rich and prey on the poor and sick for our money". In my personal opinion it goes along with the sense of entitlement that is running rampant in the country. Healthcare is assumed to be a right and not a privilege. It is a definite privilege! We are so fortunate to have these men and women who sacrifice 12+ years of their lives to gain the knowledge to alleviate pain and suffering. Be grateful! And the distinction is that the word doctor is associated with that stigma created by the media and lawyers. Psychologists just don't make enough money for the lawyers to target and therefore the media doesn't care and they fly under the radar of disrespect. Eventually our pay will decline enough to where the lawsuits aren't profitable enough for the lawyers and maybe then healthcare will become more affordable.

Yes, I do have a problem with lawyers. 😡
 
It is true to most training programs are becoming more biologically based. I also think that no matter how much psychology is taught, one needs further education after residency/or postdoc or whatever for iatrist or ologist, to be a very good therapist.
That aside, I think psychiatrists get more blame for the following reasons:
1. Our patients are 'sicker': by the time meds are needed, the degree of pathology is simply deeper.
2. When you give out meds, the transference, both positive and negative, are just more pronounced. Giving out meds is nurturing, not prescribing the latest fad that the patient sees on TV is withholding...etc.
3. Psychiatrists have more malpractice coverage...
I can't think about anything else, that is all for now.
 
outofhere said:
It is true to most training programs are becoming more biologically based. I also think that no matter how much psychology is taught, one needs further education after residency/or postdoc or whatever for iatrist or ologist, to be a very good therapist.
That aside, I think psychiatrists get more blame for the following reasons:
1. Our patients are 'sicker': by the time meds are needed, the degree of pathology is simply deeper.
2. When you give out meds, the transference, both positive and negative, are just more pronounced. Giving out meds is nurturing, not prescribing the latest fad that the patient sees on TV is withholding...etc.
3. Psychiatrists have more malpractice coverage...
I can't think about anything else, that is all for now.


How does having coverage = getting blamed...and for what again?


BTW- Are you a med student/resident?
 
Solideliquid said:
How does having coverage = getting blamed...and for what again?


BTW- Are you a med student/resident?


I thought our malpractice was about 7K a year - OPD CAN YOU QUANITITATE THAT NUMBER? Is that the right word? "Quantitate" or is it "qualitate" :laugh: or "quantify" 😕
 
Well traditionally, if you have insurance, although it might protect you from paying, it also makes you a more attractive suing target.
 
Having a Psychology degree myself, and having worked with several Ph.Ds in psychology as well as attending psychiatrists, I think I can safely say that it would be unfair to say that our education is "richer".

(I don't know if that was meant as a comparison to psychologists)

Our curriculums are different, but comparing one as perhaps better than the other is comparing apples to oranges.

As I mentioned above, much of the MD/DO curriculum has no direct bearing on behavioral therapy whatsoever. E.g. memorizing a bunch of histology slides has not yet provided any benefit to my psychiatric patients whatsoever.

Compare this to psychology where pretty much 100% of the information taught in their curriculums are of direct benefit to a psychology patient.

I'm not trying to bash psychiatry. I am a psychiatry resident. Just saying that psychologists are valuable partners in the mental health community and we should be treating them with respect & vice versa. From my own experience psychologists know a heck of a lot more than we do in several areas we should know about if we care about our own level of quality.

As for liability: practicing psychologists do also have to pay for liability, though I do not know how their liability differs from ours.
 
Thanks for the vote of confidence Whopper! I would do the thumbs up but I have a tendency to do the quick posts.
 
At least here in MA, a psychologist can't hospitalize a pt against their will (can get them to the ED, but requires physician eval and legal documentation to get admitted), they certainly can't administer medications against a pt's will, and I've never seen a psychologist involved in a mechanical restraint (not saying it never happens, just never seen it). Those all seem like pretty good reasons why psychiatrists are the leading targets.
 
Well said Whopper 🙂 I have always wondered about the sketchy level of psych training for psychiatrists considering psychologists study psych for several more years than psychiatrists do. I have always loved psych and I do like the biological side of it more which is why I am pursuing psychiatry. I was, however, a bit surprised when I read over my curriculum for my future MD school, and the amount of psych training other than from 2nd year residency was minimal. I truly believe that one has to have a full understanding of the biological self to prescribe meds and be a "MD" if you will, yet considering that their are psychiatrists and psychologists with the same intentions and interests, it seems a little unsettling when they seem to be at each others throat or contradict each other. I do have a lot to learn so maybe that will make much more sense throughout my education. I do believe it is much easier for "iatry" to be "blamed" or attacked as the "iatry" spectrum tends to deal with more severe patients. You can't necessarily "talk" someone out of schizophrenia just as you can't put a band aid on someone using meds when they would truly benefit from some good therapy. My point is, no one is better than the other, psychiatrists are just targeted more because they deal with more severe patients and have been stigmatized throughout the world, especially with the pop culture today. Although, as much as I love psychologists, they seem to play a leading role in the stigmatization on psychiatrists due to the different levels and types of care they provide. Regardless, I love the both, I just happen to love psychiatry more!!! 😀
 
Solideliquid said:
How does having coverage = getting blamed...and for what again?


BTW- Are you a med student/resident?

I am curious about what you think I am, and why you ask.

So do tell.

But, just to be forthcoming, I am a resident. I meant to say that I think psychiatrists tend to have more malpractice coverage, that our insurance have limits in the millions, although I have no idea how much psychologists typically buy for their practices. It does seem like psychiatrists are sued much more frequently, for the reasons Old Psych Doc mentioned.

Speaking of the difference in education- I have always wondered what psychologists are taught in Ph.D. school- it seems like they are taught a lot about research techniques, various theories, and they also have some long term therapy work? Maybe someone can enlighten me. I do stand firm though that I think a newly minted Ph.D. or Psy.D. can still use further psychodynamic psychotherapy training at various psychoanalytic institutes, just the same for new psychiatry attendings.
 
Psyclops said:
... Also, you may have noticed (for those who visit both) that the psychiatry forum is much more active. Now, as some also might have noticed, the psychiatry forum has been visited by quite a few more frustrated past patients than the phd/psyd board. ....The question is: Do you think it is the psychopharm, or inpt work, or the fact that the board is more active, or some other aspect that leads frustrated patients to come here and vent as opposed to the psychology forum? And furthermore, out in the real world, do you think people tend to be more frustrated by psychiatrists than psychologists?

People see psychiatrists as the medical, powerful board of the psychology/psychiatry realm. They are MDs by and large, and are "the man" or "the power" in terms of their influence. PhDs are publically associated with academic institutions and research, don't push drugs on patients, and are viewed publically as more "touchy-feely" ie. therapists. They're outside of the medical model and the people know this.

The psychiatrist, I think, is viewed as yet another busied, hurried physician that has little time for extended patient visits, and is more interested in money.
 
whopper said:
Having a Psychology degree myself, and having worked with several Ph.Ds in psychology as well as attending psychiatrists, I think I can safely say that it would be unfair to say that our education is "richer
(I don't know if that was meant as a comparison to psychologists)".
The richer comment was in the context of the education now verses the past
As I mentioned above, much of the MD/DO curriculum has no direct bearing on behavioral therapy whatsoever. E.g. memorizing a bunch of histology slides has not yet provided any benefit to my psychiatric patients whatsoever.
It helps me when I am assessing brain functions and I am referencing my anatomical knowledge. It all builds on eachother.

Compare this to psychology where pretty much 100% of the information taught in their curriculums are of direct benefit to a psychology patient.
Right, that is why we treat psychiatry patients.

I'm not trying to bash psychiatry. I am a psychiatry resident. Just saying that psychologists are valuable partners in the mental health community and we should be treating them with respect & vice versa. From my own experience psychologists know a heck of a lot more than we do in several areas we should know about if we care about our own level of quality.
So we should eliminate their role by educating ourselves in psychology? It is a symbiotic relationship. We don't spend the time to know this stuff so we can focus on our job. Let them do theirs.
As for liability: practicing psychologists do also have to pay for liability, though I do not know how their liability differs from ours.
who cares, I know we make plenty more the difference.
 
According to the American Psychiatric Association, and the College of Psychiatry & Neurology, we're expected to know a heck of a lot of Psychology.

That's why its in our PRITE & Board examinations.

There's a wealth of Psychology in Kaplan & Sadock: considered the gold standard Psychiatry text.

But there is somewhat of a line. I do get your point. I was misinterpreting one of your comments, and you are right: all of it builds on each other.
 
outofhere said:
Speaking of the difference in education- I have always wondered what psychologists are taught in Ph.D. school- it seems like they are taught a lot about research techniques, various theories, and they also have some long term therapy work? Maybe someone can enlighten me.

Excellent question! I've been on here a lot to talk about my positive interdisciplinary experiences. But that is one area of frustration for me - that my colleagues in psychiatry don't always understand what our training consists of. It's not a huge problem, but one I've found that sometimes hinders communication (like the time someone tried to define axis IV for me - when I was an intern).

In any case, there's a lot of variability, but there are also some commonalities. We receive in-depth training in psychopathology - inlcuding theorized etiological models (usu. from a biopsychosocial perspective, with particular emphasis on the "psychosocial"), course and outcome characteristics, predictors of course, and assessment and treatment. We are trained to approach all of these areas from an empirical perspective - our accumulation of knowledge in each these areas is typically achieved through a crticial review of the the research literature. For example, there were very few books that I was required to buy as a grad student. Almost all of my required reading came from journal articles.

In addition, we take advanced statistics coursework (e.g., SEM, multilevel modeling, etc.), and specific coursework on research methodology. We are required to conduct our own independent research (minimally the master's thesis and dissertation) and to publish within our specialty areas. We are also required to take coursework outside of clinical psychology - in areas such as biopsych, cognitive psych, and social psych, as mandated by APA. Several psych grad students also spend a lot of time teaching undergrads.

Finally, we receive applied training. We learn measurement theory and test construction, in addition to being trained to conduct structured (e.g., inelligence, personality) and unstructured clinical assessment. We also receive supervision and training in psychotherapy - with some exceptions, most clinical psych grad students start to see psychotherapy patients during their second year of training, and carry their own caseload throughout the remainder of training. We see psychotherapy patients in a variety of settings - university clinics, hospitals, community mental health centers, etc. Although some programs emphasize certain therapy models, most will provide supervision in a variety of approaches (dynamic, humanistic, CBT, IPT, CBASP, DBT, ACT, couples and family, etc.)

The description above is pretty generic - there are certain areas that students can sub-specialize in such as neuropsych and health psychology. In these cases, training might look different.

Anyway, I'm not writing all of this to say "we know more than you" - but rather, I thought I might just clarify what it is that we do know (which, as already said, is partly the same and partly different than what you all know!).

🙂
 
I think two of the primary reasons for increased frustration with psychiatrists are differences in time spent with patients and the drug mythology. Psychiatrists are not allowed to spend as much time with patients so some patients end up feeling neglected. This is especially true for the needy Axis II ones who are also the patients particularly likely to end up disgruntled. Also, there is a pervasive belief that medication can alleviate all suffering. When patients discover this isn’t the case, many conclude that the issue was their incompetent, withholding, and downright mean psychiatrist rather than a problem that simply cannot be medicated away.
 
I have a couple questions that weren't addressed.


1. how much does it COST for psych malpractice insurance

2. how much does it COVER (up to what dollar amount)


and also food for thought:

during orientation today the board of medical licensing came in to talk to us, he made sure to reiterate the point that psychiatrists (he was talking to ALL the residents, not just psych residents) were the one specialty that will be held to a higher standard of conduct when it comes to patient care. He said this not once - but 3 times, he is an anesthesiologist by training. I thought that was intersting, and you saw the row of us new psych interns kinda flinch like OH NO, what does THAT MEAN? 😱
 
Higher standards than other specialties? Or higher standards than they have in teh past?
 
1 mil/ 3 mil is the standard coverage accepted for hospital practice. This is what I have and most psychiatrists I know in Ca. have the same.

🙂
 
Poety said:
I have a couple questions that weren't addressed.


1. how much does it COST for psych malpractice insurance

2. how much does it COVER (up to what dollar amount)


and also food for thought:

during orientation today the board of medical licensing came in to talk to us, he made sure to reiterate the point that psychiatrists (he was talking to ALL the residents, not just psych residents) were the one specialty that will be held to a higher standard of conduct when it comes to patient care. He said this not once - but 3 times, he is an anesthesiologist by training. I thought that was intersting, and you saw the row of us new psych interns kinda flinch like OH NO, what does THAT MEAN? 😱


ouch.
 
Psyclops said:
Higher standards than other specialties? Or higher standards than they have in teh past?


Higher standards than other specialties. He went on to say that his reasoning or the boards reasoning or whatever, was because psychiatrists have the most control over their patients in the sense that they know everything about them, things other doctors don't. He also said that patients are most influenced by their psychiatrists, therefore, they are held to higher standards. I think what that means is, a slap on the wrist or mild reprimand to say, an internist can be a sanction on a psychiatrists license.
 
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