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Psychiatry psychologist relations

Discussion in 'Psychiatry' started by DrRedstone, May 19, 2017.

  1. DrRedstone

    DrRedstone Medical Student

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    I'm starting medical school in the fall and currently working in an ophthalmology clinic. I have heard a lot about how optometry is slowly encroaching on the field and gaining more privileges for procedures and minute surgeries in a few states. Here's a link to one such discussion.

    How do you feel about your professional relationship with psychologists and what their role is as part of the mental health team?
     
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  3. Merovinge

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    It's a somewhat harder question in reality than I wish it was. I think a lot of sensible people find a clear distinguishing role between the two and in many places we co-exist in a mutually symbiotic way that is helpful for patients. Other places, it's a real turf war, with PsyD's at diploma mill schools fighting to get prescribing rights with minimal oversight.

    Ideally, psychologists are specialists in areas of psychotherapy (CBT, DBT, PMT, etc.) and offer these invaluable services along with (depending where you are at) helping to train or inform psychiatrists about their work. They frequently do research in these fields as well giving them extreme depth of knowledge. Psychologists also own the market on psychologic and neuropsychologic testing which can be extremely valuable to psychiatrists, particularly in pediatric work. Most psychiatrists are dying to have good psychologists to refer to for therapy and many psychologists are similarly thrilled to have good psychiatrists to refer to for meds.

    Generally speaking, I love working with psychologists and appreciate their ability to do so much research or just practice with very specific modalities. I occasionally run into psychologists who feel the have the same breadth of knowledge about human physiology, psychopharmacology, management of acute psychosis, and medical/legal issues; this leads to silent grinding of my gears.
     
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  4. Armadillos

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    Atleast speaking from a residents standpoint, I've always had really good interactions with psychologists. Haven't sensed any feeling of competition or turf battles in my local medical community. Only time I occasionally get a tiny irritated is when a psychologist (or PharmD) insists on having a very strong opinion about some sort of situation they are completely insulated from and can't understand because they aren't covering an inpatient hospital while taking care of patients in the ER at 2am. That being said, that rare annoyance is vastly outweighed by the benefits of having good collaboration.
     
    #3 Armadillos, May 19, 2017
    Last edited: May 19, 2017
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  5. Mad Jack

    Mad Jack Critically Caring
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    Psychologists and psychiatrists get along swimmingly in my area. LCSWs too. There's too much work to be done for people to get upset about stepping on one anothers' toes.
     
  6. smalltownpsych

    Psychologist

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    Agreed with much of what you said except many of us do have extensive training in legal and ethical issues related to mental health as it is one of our core competencies. Where that deviates from the medical might be the problem that you are running into as we are operating from a related but separate set of ethical principles. Then again it could be just a psychologist popping off with stuff they don't know in a misguided ego competition. I have seen examples of both at play. We called it the morning meeting at the state hospital.
     
  7. Bartelby

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    My experience working with psychologists has been great. The ones I have worked with were well-trained and made my life easier. When you are in a team-based setting, having competent team members to divide up the work with makes the work much more bearable, especially when you use each discipline's strengths appropriately.

    They also can conduct and interpret a lot of testing that we typically don't do, from neuropsychological testing to personality assessments.

    The political/turf wars I have encountered were all on the internet. Maybe I have just been lucky, but I doubt it. I think of psychologists as valued colleagues.
     
  8. AcronymAllergy

    AcronymAllergy Neuropsychologist
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    From the "other side" (i.e., psychology), I've never consistently run into problems working with psychiatrists. Like Merovinge mentioned, I'm thrilled to have available my psychiatrist colleagues' knowledge and expertise. I regularly pick their brains about random pharmacological and general medical questions.

    Anytime I've seen consistent conflict, it's more a matter of personality characteristics than profession. The person was a jerk well before they started grad/med school.
     
  9. Nasrudin

    Nasrudin Apropos of Nothing

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    Relations are good. There's real benefit for all by our collaboration. I agree that a bad relationship would likely be for other reasons than professional difference.

    I also like healthy competition. I like starting over in things I don't know. And it's a privilege to be a white belt amongst black belt psychologists in a personality disorder clinic.

    Yeah. I get competitive. in that sense. but it's because I want to learn and get good at this. i don't want to lose that. I also have more respect for psychologists who are pursuing our medical/neurological/pharmacological knowledge and who engaged in learning that from us. I think those of us from both camps that aren't interested in the other.... well... then... they're just chaff in the competition for excellence.
     
  10. industrialengineer

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    Never had any problems. I've learned a lot from them.
     
  11. xavier2000

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    We have a bunch of psychologists around. Some are great. Some do have a chip on their shoulder. The younger ones seem to have the most issues with no being a physician.
     
  12. TikiTorches

    Physician Gold Donor Classifieds Approved

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    They are welcome to go to med school
     
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  13. WisNeuro

    WisNeuro Board Certified Neuropsychologist
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    Meh, many of us have taken med school coursework. Too easy. We were looking for something more challenging ;)
     
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  14. Merely

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    More difficult coursework to earn 1/5th the income, sounds prudent ;)
     
  15. WisNeuro

    WisNeuro Board Certified Neuropsychologist
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    I think you are underestimating my income. And also my free time and lack of debt to increase my passive income stream ;)
     
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  17. TikiTorches

    Physician Gold Donor Classifieds Approved

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    Perhaps he is underestimating your income, but not the majority of psychologists incomes. There are outliers to any bell curve and you are a neuropsych which is specialized and not the majority of psychologists.

    And taking some med school classes is not the same as being in med school. :)
     
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  18. WisNeuro

    WisNeuro Board Certified Neuropsychologist
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    Of course, that is obvious, but generally besides the point. My comments were more a commentary about the "chip on the shoulder" comment and the irony therein.
     
  19. TikiTorches

    Physician Gold Donor Classifieds Approved

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    Then that is my error. Since you quoted Merely, I took that to mean you were referring to his comment only.
     
  20. MacDonaldTriad

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    Anyone but a complete moron can comprehend classes in medical school. None of the concepts are that tough. It isn't like modern physics or advance mathematics. It is incredibly broad and mundane in detail. It is a lot like getting a drink from a fire hose while learning a new language and trying to figure out how to get people to modify behavior all at the same time. Other than that, a walk in the park really.
     
  21. thoffen

    thoffen Member

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    The answer to everything is "it depends". Except I can confidently say that I have no fear whatsoever that psychologists will cause me to lose patients or income or change my practice, with or without prescribing rights.
     
  22. smalltownpsych

    Psychologist

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    That actually makes a lot of sense as they probably aren’t comfortable with their own professional identity or role and haven’t figured out how much better we are than psychiatrists anyway! :poke:
     
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  23. Crayola227

    Crayola227 The Oncoming Storm
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    Before I got an Rx pad, I definitely had a chip on my shoulder about not having one. Many people do. So they make a trip to Mexico or get an MD. It's all perfectly natural.
     
  24. TikiTorches

    Physician Gold Donor Classifieds Approved

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    Tell me about the comprehension level and education of the average American. And comprehension and mastery or competence of the material are two different things.

    And I dont know when or where you trained, but medical school was not a walk in the park for my colleagues or me especially with the competitive class setting full of medical students. The bar was very high as medical students are already culled from the herd of undergraduate school, post bacc programs, previous graduate schools, etc
     
  25. SeniorWrangler

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    What do they have in Mexico? Enough margaritas to help one forget their lack of prescribing privileges?

    My main problem with psychologists is that they aren't available to see my patients.
     
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  26. medium rare

    medium rare Psychologist & Psych NP

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    In my experience, good psychologists are just as busy as psychiatrists. Seeing one patient per hour (on average) fills a schedule quickly if you’re worth your salt.
     
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  27. smalltownpsych

    Psychologist

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    Now you know why they can’t see your patients...because they are in Mexico drinking their troubles away.
     
  28. Crayola227

    Crayola227 The Oncoming Storm
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    You don't need prescribing privileges in Mexico.

    I know all sorts of people from doctors to patients that go to the pharmacies there to load up on all sorts of drugs they want.
     
  29. PSYDR

    PSYDR Psychologist

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    I noticed this thread has a the tendency to claim psychologists are envious of prescribing prvibleges, have lesser knowledge in subjects that are not exclusively the purview of psychiatry such as legal, etc while questioning if there are problems with psychiatry psychology relationships.
     
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  30. Mad Jack

    Mad Jack Critically Caring
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    You say that, but I'd love to see you sit down with the average Medicaid patient and have a discussion about histones and methylation
     
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  31. st2205

    st2205 Attending

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    At this point, I don’t even know if I could hold an intelligent conversation about histones and methylation.
     
  32. Nasrudin

    Nasrudin Apropos of Nothing

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    Wow. Your average medicaid patient listens to conversations about histones and methylation? I think it's possible they're just smiling and nodding.
     
  33. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    Mostly nodding...off.
     
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  34. Mad Jack

    Mad Jack Critically Caring
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    That's kind of my point. Like, you just couldn't explain these concepts to them and have them understand them on anything but the most basic level. Not that there's anything wrong with that, I just feel like we often take for granted just how much of a foundation we have to build before things like this are easily understood. To most people, we may as well be speaking Swahili.
     
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  35. TikiTorches

    Physician Gold Donor Classifieds Approved

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    The Price of Medical Illiteracy
    The Price of Medical Illiteracy
    Not understanding what doctors say is costly for patients' health and for health care itself.
     
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  36. AcronymAllergy

    AcronymAllergy Neuropsychologist
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    Health/medical literacy is, unfortunately, something that can be easily overlooked, due to (as Mad Jack said) under-appreciation of the complexity of the information presented, limited training and practice in delivering "digestible" instructions, and time constraints.
     
  37. st2205

    st2205 Attending

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    I’m always amazed. I think people underestimate how hard it is to follow instructions, even when simple. I spell out the plan with every patient in bullet points and print them a copy. People still come back not infrequently having no idea WTF they were supposed to do (and that’s just the people who admit it).
     
  38. AcronymAllergy

    AcronymAllergy Neuropsychologist
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    Yep, I do the same, and many folks still unfortunately end up misunderstanding or only partially understanding their results and my recommendations. I suspect there's a bit of "information overload" that occurs, and we (as humans) aren't always great at remembering information that we hear to begin with. Especially if there's limited framework to hang it on. Sometimes, we just need to hear it a few times for it to finally sink in, so I'll try to repeat the most important points throughout my appointments. Having the patients actively participate rather than passively listen (e.g., "tell me your understanding of what we've talked about so far") can also go a long way.
     
  39. MacDonaldTriad

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    Why should Medicare patients be any different than medical students?

    Honestly guys, I didn't say medical school was easy, I said none of the concepts are that complex, it was very competitive and infinite for sure.
     
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  40. clausewitz2

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    Yeah, I think basically until you come up against any field which requires a grasp of mathematics more sophisticated than what you are likely to learn in high school you will have never had the experience of what a truly difficult concept is. Not "oh, there's a lot of detail, I better study it for many hours to get a good grasp on all that detail" and more like "I have been thinking and reading and trying to practice this one thing for the past week and I still have no idea what is going on and want to cry when I think about it." It is a whole different kettle of fish from the massive grab bag of facts and hazy conceptual linkages between them more typical of medical education.
     
  41. FlowRate

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    I never had the experience in med school of spending an hour re-reading and discussing a single page in a textbook, just trying to figure out exactly what's going on. That was a regular occurrence in advanced thermodynamics, physical chem (quantum), etc.

    ... I'm having flashbacks to the number of times we learned new things about algebra in pchem lecture. By algebra, I mean arcane identities related to multivariate calculus equations.
     
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  42. WisNeuro

    WisNeuro Board Certified Neuropsychologist
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    Yeah, most subjects like neuroanantomy/pathology, chem, calc, neurobiology, etc were not hard. Anyone with above average intelligence can do relatively fine in most subjects with minimal study time. I think the only time I ever had to sit down and really go through material was upper level statistics, HLM and the like.
     
  43. MacDonaldTriad

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    The three of you have just articulated what I was trying to say very well. Going from differential Calculus to medicine is like shifting from ultra low gear on a hill climb to overdrive on a steep down hill with a tail wind, but you are still in a race in both cases.
     
  44. AcronymAllergy

    AcronymAllergy Neuropsychologist
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    My roommate in grad school was working toward his doctorate in a theoretical branch of math. That was a whole different kind of smart. One I'll never have.
     
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  45. MamaPhD

    MamaPhD Psychologist, Academic Medical Center
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    Yeah, I took 5 stats courses in grad school but had only a superficial introduction to matrix algebra, which intrigued me but also made me realize that if I delved any deeper I'd have to get tutoring from a math undergrad. I had statistical software syntax to learn, and that was both easier and more pragmatic to prioritize. Hats off to the mathematical statisticians.
     
  46. valid username

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    Yesterday I was looking thru a pt's EHR and checked out his notes from psychology. Um, yeah. Our psychiatry notes don't look like that. Those notes were impressive:=|:-):!
     
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  47. AcronymAllergy

    AcronymAllergy Neuropsychologist
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    Pros and cons. Sometimes we (psychology) write ridiculously long and superfluously detailed notes for no one's sake but our own. It's one of the main areas on which I have to work with trainees; lots go through grad school and are used to writing 10 page reports for fairly standard intakes. Heck, I'm still unhappy with how long my own notes are.
     
  48. erg923

    erg923 Regional Clinical Officer, Cenpatico National

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    Long notes in an EHR, assuming its not a formal psychiatric/psychological evaluation or forensic in nature, is bad for everyone involved. Inefficient use of time for the provider, not necessary for billing, unnecessary disclosure/documentation of very sensitive PHI and personal details, etc.
     
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  49. valid username

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    I never said it was long. It was organized well and was quite helpful. The patient is extremely aggressive. So the few extra bits of information were helpful in knowing how to set him off less.
     

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