Psychologists Defeated in Hawaii Again

[Anasazi23]

The forum has a thread on psychiatry respect? Then it must be a huge issue in healthcare. It's a pre-med thing. Don't fall for the hype. We have the busiest consult service in the hospital (next to perhaps ID). I think most others will attest to a similar situation.

I should probably clarify my opinions regarding diagnosis. Of course, like in any illness, accurate diagnosis is important.

But again, the medical model is perhaps different from what you're used to.

If you have diabetes and are in DKA, I don't care much how you got there. When I was doing my medicine months, I treated it. Did we educate them about proper insulin usage and diet? Of course. The point is that we treat the symptom complexes that are given to us, all the while taking history and etiology into account. You may not believe it, but it's true. A common example that comes to mind is the daily request by a new drug-induced mood disorder (read cocaine/heroin addict) patient who now complains of depression to start an anxiolytic or antidepressant. I take the etiology into consideration and in only certain circumstances, prescribe said medication.

I disagree that medicine treats etiologies and symptoms. Surgery generally doesn't. ID doesn't. Gynecology generally doesn't. Medicine rarely does. Cardiology does sometimes. Dermatology and neurology rarely do. I'm thinking of the bread and butter representative disease states for said specialties.

Example: CHF. Why did she get it? Who cares....she's going into failure. Stop the IVF, start the natrecor, etc.

Again, not saying diagnosis isn't important, but it's only part of the picture. I'd rather discharge a patient without a clear diagnosis but good control of symptoms, than have a solid diagnosis resistant to treatment.

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[PsychEval]

Illinois Psychological Association.
Enough said.


Of course, insurance companies suck. Period. My experience is very different, since I'm in a major city. I'm not sure if that means that underqualified persons should therefore act as mini-psychiatrists.

I watched that insipid video from the Illinois Psychological Association. Again, with poorly selected dire music and all, it amounted to ridiculous propagandized claims that the entire state is going to descend onto psychopathic madness if psychologists don't get prescription privilages.

Does anyone have an extra copy of the REAL PSYCHIATRY, DOCTORS IN ACTION video?

 

[50960]

Sazi, I agree with you again. However, I do think most licensed clinical psychologists with some experience feel the same as you regarding Dx and Tx...the goal is Sx reduction. Obsessing over Dx modifiers is part of being a psych STUDENT, not a practitioner, but this is a student board. I agreed with your previous post because 1) I feel organized psychology is in the dark ages and needs to medical up...at least to the RN level to even allow people to practice, 2) I am not an APA member or a psychology-sheep buying in to the party line, and I do not believe any of the BS propaganda against psychiatry they are using, and 3) I have chosen to practice how I do, and get trained how I have (by psychiatrists) because I am not happy with party-line psychology. You make good point when you get away from attacking and defending, and that is what I agreed with...re-read what you wrote, and I agree with it.
For what it is worth I am sorta a black-sheep in my field (I know I said was not a sheep at all??), and have been accused often of being a psychiatrist-wanna be by my peers. I am not. If I were I would have become a psychiatrist. I am only 35 I still could, but that is not what I wanted or want. Like you I want psychology to get a grip on itself and rise to the occasion. Psychiatrists will always be the best trained to treat major medical illness, but someone has to treat the other 90%...that's me.

 

[Psyclops]

Another $.02 about diagnosis, for those research and theory minded folks (are those dirty words on this forum?) diagnosis and diagnostic system can and will be a big deal. And to the extent that the field (MH TX) keeps advancing it will trickle down to the practitioners and might begin to matter to them.

 

[Anasazi23]

Interesting post, Psisci.

Hmm..
I pictured you to be a little older.

In truth though...and I sincerely don't mean to fan the flame but,
You seem much more in tune and your interests seem to follow much more of the psychiatry and medical-model line of approach, diagnosis and treatment than most psychologists.

Why didn't you become a psychiatrist? For me, it was a huge decision to switch. As all can tell...I'm very glad I did. I knew I was missing a lot, and now that I'm a physician...I wish that some on the board could know how much they don't know about the human body as a whole. God knows I'm still light years away, and I try to keep up as best I can. If your reason for not becoming a psychiatrist was time or pay cut, or intimidation of the prospect of med school + residency, I can understand that too.

I've known older people that have gone to med school. You wouldn't have to worry about all this rxp crap, would have full hospital privilages to treat in any manner you saw medically fit, could prescribe anything you wanted without worrying about retribution or if you get caught not attending supervision with the MD or not having a chart reviewed with them prior to prescribing something, etc.

I mean, I just can't imagine having to tell my patient in the office in front of me: "Let's see Mr. Jones...you definately need to start this Valproic Acid today. Let me call your PCP, Dr. X." Phone rings and the office girl says that Dr. X is out golfing today. You return to the patient. "Well Mr. Jones, I'm sorry, but I can't prescribe this for you today because your PCP is away. Think you'll last till next week? Try to get off this manic kick of yours."

I'm not trying to incite..just thinking of the real-world scenario.

 

[Psyclops]

BTW, Ana, I can't believe you watched the video, I turned it off 30secs in.

 

[PublicHealth]

Sazi, I agree with you again. However, I do think most licensed clinical psychologists with some experience feel the same as you regarding Dx and Tx...the goal is Sx reduction. Obsessing over Dx modifiers is part of being a psych STUDENT, not a practitioner, but this is a student board. I agreed with your previous post because 1) I feel organized psychology is in the dark ages and needs to medical up...at least to the RN level to even allow people to practice, 2) I am not an APA member or a psychology-sheep buying in to the party line, and I do not believe any of the BS propaganda against psychiatry they are using, and 3) I have chosen to practice how I do, and get trained how I have (by psychiatrists) because I am not happy with party-line psychology. You make good point when you get away from attacking and defending, and that is what I agreed with...re-read what you wrote, and I agree with it.
For what it is worth I am sorta a black-sheep in my field (I know I said was not a sheep at all??), and have been accused often of being a psychiatrist-wanna be by my peers. I am not. If I were I would have become a psychiatrist. I am only 35 I still could, but that is not what I wanted or want. Like you I want psychology to get a grip on itself and rise to the occasion. Psychiatrists will always be the best trained to treat major medical illness, but someone has to treat the other 90%...that's me.

Great post! Can you expand on what you mean by "party-line psychology?"
Also, what, in your opinion, must psychology do to "get a grip on itself and rise to the occasion?" Rock on, psisci!

 

[Doc Samson]

Why won't this thread just die? Please psychologists, go back to your own forum. If psychiatrists are less capable diagnosticians and researchers, then there's nothing of value for you here, other than trolling. The vast majority of psychiatrists are against psychologist prescribing, you aren't going to convince us of anything else. If you'd like a psychologist prescribing thread start it on your forum and invite us to contribute. I'm just sick of seeing this back and forth sniping.

 

[Psyclops]

I mean, I just can't imagine having to tell my patient in the office in front of me: "Let's see Mr. Jones...you definately need to start this Valproic Acid today. Let me call your PCP, Dr. X." Phone rings and the office girl says that Dr. X is out golfing today. You return to the patient. "Well Mr. Jones, I'm sorry, but I can't prescribe this for you today because your PCP is away. Think you'll last till next week? Try to get off this manic kick of yours."

I'm not trying to incite..just thinking of the real-world scenario.

Not incited, but I like playing the hypothetical game. Mr. Jones is manic now right? Depakote gonna bring him down safely immediately? He'll be wrestling with those symptoms for another week anyway probably. So what should we do, his mood needs stabilized. Should we call a psychiatrist? Mr. J doesn't live in NYC, he lives in central Pennsylvania. No appointments for three months. Punxutawney hospital doesn't have a psychiatric wing. We could just page the MD we're coordianting with. Have him write the script, Mr Jones can stop by the course on his way to RiteAid. No biggie.

 

[Psyclops]

Why won't this thread just die? Please psychologists, go back to your own forum. If psychiatrists are less capable diagnosticians and researchers, then there's nothing of value for you here, other than trolling. The vast majority of psychiatrists are against psychologist prescribing, you aren't going to convince us of anything else. If you'd like a psychologist prescribing thread start it on your forum and invite us to contribute. I'm just sick of seeing this back and forth sniping.

I thought that for the most part we we're having a civil conversation. If one of the mods wants to move it though that would be fine by me. What does it matter where the post is.

 

[Psyclops]

Although, I'll admit I have to even click on the most boring and anoying posts just to get the dark blue line off my screen.

 

[PublicHealth]

Interesting post, Psisci.

Hmm..
I pictured you to be a little older.

In truth though...and I sincerely don't mean to fan the flame but,
You seem much more in tune and your interests seem to follow much more of the psychiatry and medical-model line of approach, diagnosis and treatment than most psychologists.

Why didn't you become a psychiatrist? For me, it was a huge decision to switch. As all can tell...I'm very glad I did. I knew I was missing a lot, and now that I'm a physician...I wish that some on the board could know how much they don't know about the human body as a whole. God knows I'm still light years away, and I try to keep up as best I can. If your reason for not becoming a psychiatrist was time or pay cut, or intimidation of the prospect of med school + residency, I can understand that too.

I've known older people that have gone to med school. You wouldn't have to worry about all this rxp crap, would have full hospital privilages to treat in any manner you saw medically fit, could prescribe anything you wanted without worrying about retribution or if you get caught not attending supervision with the MD or not having a chart reviewed with them prior to prescribing something, etc.

I mean, I just can't imagine having to tell my patient in the office in front of me: "Let's see Mr. Jones...you definately need to start this Valproic Acid today. Let me call your PCP, Dr. X." Phone rings and the office girl says that Dr. X is out golfing today. You return to the patient. "Well Mr. Jones, I'm sorry, but I can't prescribe this for you today because your PCP is away. Think you'll last till next week? Try to get off this manic kick of yours."

I'm not trying to incite..just thinking of the real-world scenario.

Ah, the mod doing some recruiting to alleviate the shortage of psychiatrists! Just kidding Hmm...maybe you should visit some clinical psychology programs and talk some sense into those kids! You helped me decide between medical school/psychiatry and graduate school/clinical psychology. Thank you for that. I'm happy with my decision, though I crave research each day (statistics fetish, perhaps?).

Regarding the collaborative practice agreement, I recall reading somewhere that medical psychologists in Louisiana do not have to call their patient's PCP each time they prescribe. It was more like the PA/NP set-up, where a certain percentage of charts are reviewed. One of the medical psychologists on the Division 55 also claimed to handle consults for psychotropics in several hospitals. We should try to track one of them down to get some more perspective on medical/prescribing psychology (as Doc Samson suggested, perhaps we'll do that in the clinical psychology forum). Does anyone have more information on this?

 

[Poety]

The bastard of Winterfell is back in action!

I knew that bastard was lurking around

 

[PublicHealth]

100% of what I do is bio-related.

Clinically? If so, could you please elaborate? Are you referring to neuropsychological assessment?

Caccioppo, Davidson, and Tranel do some great work. I would not want them to treat me for a neurologic or psychiatric disorder, but I certainly think they know what they study in excruciating detail. No doubt about that.

 

[Poety]

Not gonna happen. I like what I do, I don't need to prescribe.

I've been adamantly against psychologists prescribing drugs, but am now wavering.

I'd want the following:

No diploma mills

grad school class in bio bases of behavior and at least two other bio oriented courses.

2 year clinical pharmacology fellowship/postdoc similar to neuropsych model. Except, board certification should be absolutely mandatory for practice (as it should but isn't for current psychology specialties).

I'd buy the psychiatry argument against psychologists if it weren't for:

optometrists
nurses
nurse practitioners
physician's assistants
nurse anesthetists
primary care physicians and so on. . .

Psychology shouldn't be lumped in as a midlevel provider, but with respect to psychopharm they would be. I think psychologists could be potentially excellent alternatives for psychopharm to say a nurse or PCP. Everyone generally has a PCP anyway so, just like psychiatrists, psychologists should/could refer out for other conditions/checkups.



*bow*

- I wonder if I'm still on Poety's ignore list.

And none of these people should be prescribing either - they're dangerous pelase refer to any of my numerous anecdotes detailing the danger...

and you're not on my ignore list.... yet (haven't gottent hrough this thread yet)

 

[PublicHealth]

And none of these people should be prescribing either - they're dangerous pelase refer to any of my numerous anecdotes detailing the danger...

and you're not on my ignore list.... yet (haven't gottent hrough this thread yet)

Anecdotes? Show some some hard science, baby! Find some data, dammit!

 

[50960]

Simple quality of life PH. I have spent years in school, and make good $ and get to practice how I like doing what I do. I enjoy No call, no pager, and I work when and where I wish. I live well.

 

[Poety]

Anecdotes? Show some some hard science, baby! Find some data, dammit!

You ... are a journal/data FREAK!

 

[Psyclops]

I knew that bastard was lurking around

Ahhh....so you used to think I was JS.....hahaha

 

[Anasazi23]

BTW, Ana, I can't believe you watched the video, I turned it off 30secs in.

I also became very bored very quickly. I skipped around to get the highlights. But that tool at the end was too dramatic to turn off. He deserves an Oscar for that performance....the guy who's father is a pediatrician and his life's desire is to garner access to the poor children in the great state of Illinois.

Compelling stuff...

 

[Solideliquid]

Not gonna happen. I like what I do, I don't need to prescribe.

I've been adamantly against psychologists prescribing drugs, but am now wavering.

I'd want the following:

No diploma mills

grad school class in bio bases of behavior and at least two other bio oriented courses.

2 year clinical pharmacology fellowship/postdoc similar to neuropsych model. Except, board certification should be absolutely mandatory for practice (as it should but isn't for current psychology specialties).

I'd buy the psychiatry argument against psychologists if it weren't for:

optometrists
nurses
nurse practitioners
physician's assistants
nurse anesthetists
primary care physicians


- I wonder if I'm still on Poety's ignore list.

Here's what I don't like about this comparison: an optometrist will prescribe eye drops or whatever. But people don't go to them for eye infections nor do optometrists take on the responsibilty of treating vision-debilitating diseases.

EDIT: And I was wondering, did PAs and optometrists use the argument that there are not enough doctors when they wanted to prescribe?

 

[Anasazi23]

Ah, the mod doing some recruiting to alleviate the shortage of psychiatrists! Just kidding Hmm...maybe you should visit some clinical psychology programs and talk some sense into those kids! You helped me decide between medical school/psychiatry and graduate school/clinical psychology. Thank you for that. I'm happy with my decision, though I crave research each day (statistics fetish, perhaps?).

Glad I helped with the decision. Make sure you go to a research-oriented place. You'll have all the statistics and patient recruiting you can handle.

Regarding the collaborative practice agreement, I recall reading somewhere that medical psychologists in Louisiana do not have to call their patient's PCP each time they prescribe. It was more like the PA/NP set-up, where a certain percentage of charts are reviewed. One of the medical psychologists on the Division 55 also claimed to handle consults for psychotropics in several hospitals. We should try to track one of them down to get some more perspective on medical/prescribing psychology (as Doc Samson suggested, perhaps we'll do that in the clinical psychology forum). Does anyone have more information on this?

He curbside prescribes for a hospital? Let him know on the listserv that he will inevitably get his buttcheeks sued into oblivion and lose his license when he *&%$'s up and hurts a patient for practicing medicine without a license. Hospitals are completely different entities with complicated medical regulations.

 

[Anasazi23]

I'm sure these are great folks who know tons in their area.

Do they know about the human body in terms of clinical medicine?

No.

 

[Psyclops]

Why did PAs and Optometrists Etc get prescribing rights? And what were their arguments.

 

[Anasazi23]

Why won't this thread just die? Please psychologists, go back to your own forum. If psychiatrists are less capable diagnosticians and researchers, then there's nothing of value for you here, other than trolling. The vast majority of psychiatrists are against psychologist prescribing, you aren't going to convince us of anything else. If you'd like a psychologist prescribing thread start it on your forum and invite us to contribute. I'm just sick of seeing this back and forth sniping.

I'm sorry, DS. This is probably my fault, as I started the thread. I'm more detached when arguing about this stuff now...more like a game.

By the way, PublicHealth:

Witness for the Moussauoi defense.

 

[Anasazi23]

I wish you could just do one week of a medical internship year. It's quite a bit of....ache.

The brain, neuroscience, and textbook physiology divorced from clinical medicine is a different animal. That's all I'm trying to say.

 

[Anasazi23]

I hear you but I think of it this way...

While psychiatrists don't treat every medical condition by a long shot, they went through medical training, including medical internship. When I see a patient, before I even talk to them. I see them. I can make inferences about what diseases they might have and how my assessment is entirely based on the gestalt of the clinical picture - because I went to med school, had countless medical rounds, examined hundreds and hundreds of patients, and read thousands of pages of medical text.

When you do a neuro exam supervised by a neurologist, for example. you have an entire human body's worth of organ system and clinical medicine for which you haven't been trained in understanding. Pharmacology added to a neuropsychologist's mix does not a physician make. It's not just textbook knowledge either. If it were, we could all just study Harrison's and take step III in one year. The clinical rotations and in-depth organ systems classes are essential. This, coupled with clinical teaching and mentoring on the wards. I feel that I could not effectively practice without this knowledge.

Of course, I qualify this by stating that it (neuropsychology) is a different field, as is general psychology to some extent. While there are similarities between these fields and psychiatry, they are in essence, different.

 

[Doc Samson]

OK, fine, I give, but only b/c I'm moonlighting and waiting for an admission from the other side of the state to get here...

To prescribe atypicals, practice guidleines require monitoring of lipids, liver function, weight, BMI, BP, abnormal movements, etc.

To prescribe Depakote, practice guidelines require monitoring of LFTs, weight, etc.

To prescribe Lithium, practice guidelines require monitoring of renal function, CBC, etc.

To prescribe Clozaril... well you're just never going to go there.

The point is, without medical school you CANNOT monitor those things. Sure you can have the blood drawn and see if the result comes back printed in red or not, but you cannot interpret the result in the context of a single- or multi-organ system phenomenon because you have no medical training.

"Ah," you say "the PCP can do that!" You have got to be f-ing kidding me. Getting a PCP to call me back is like getting blood from a stone. Plus, adding the extra step of complexity in the system is just adding another opportunity for screw up.

Psychiatrists can prescribe safely because: a) we have training in psychiatry so we can diagnose, formulate, and choose treatment for psychiatric illness, b) we have training in medicine so that we can monitor the effects of our treatments on the body as a whole, and c) when things go bad we can at least start the appropriate intervention ourselves without having to call someone else and try to relay data that we do not completely understand.

Claiming that training in psychology + training in pharmacology = safe psychotropic prescribing seems to be based in the mind-body dualism that we should've have left behind decades ago.

 

[50960]

The point is, it is happening.

 

[Psyclops]

OK, fine, I give, but only b/c I'm moonlighting and waiting for an admission from the other side of the state to get here...

To prescribe atypicals, practice guidleines require monitoring of lipids, liver function, weight, BMI, BP, abnormal movements, etc.

To prescribe Depakote, practice guidelines require monitoring of LFTs, weight, etc.

To prescribe Lithium, practice guidelines require monitoring of renal function, CBC, etc.

To prescribe Clozaril... well you're just never going to go there.

The point is, without medical school you CANNOT monitor those things. Sure you can have the blood drawn and see if the result comes back printed in red or not, but you cannot interpret the result in the context of a single- or multi-organ system phenomenon because you have no medical training.

"Ah," you say "the PCP can do that!" You have got to be f-ing kidding me. Getting a PCP to call me back is like getting blood from a stone. Plus, adding the extra step of complexity in the system is just adding another opportunity for screw up.

Psychiatrists can prescribe safely because: a) we have training in psychiatry so we can diagnose, formulate, and choose treatment for psychiatric illness, b) we have training in medicine so that we can monitor the effects of our treatments on the body as a whole, and c) when things go bad we can at least start the appropriate intervention ourselves without having to call someone else and try to relay data that we do not completely understand.

Claiming that training in psychology + training in pharmacology = safe psychotropic prescribing seems to be based in the mind-body dualism that we should've have left behind decades ago.

Sam, I tend to respect your opinions but I think you are wrong on this one. There is alot to consider, but I think that non med school grads can be trained to effectively and safely prescribe a limited range of medications. During the specialization training not everything is giong to be covered, I can't argue that. But neither is it in med school. There will always be things that you haven't learned about, tropical diseases, whatever. I think, and I'm talking from personal experience here, that a relatively intelligent person can learn to adequately prescribe these meds in particular. It may require a handbook or more checks agains guidelines before they prescribe some of the meds that are more risky in terms of side effects than prozac. But that's ok. Moreover, during specialization practitioners pursuing these privileges will learn much of the clinical physiology needed to prescribe these medications effectively. The class doesn't strike me as being, ok you give the green one for depression, the big grey horse pill is for mood stabilisation, give the pretty pink one if patients tounge swells up after taking the orange pill that gets rid of the voices but makes them drool, etc. Clozaril might be a stretch, I agree, but even I know that you need to monitor white blood cell counts, along with extra pyramidal symptoms, etc. I think I would feel comfortable taking medication from a psychologist, I feel comfortable taking them from a PA.

 

[50960]

Even great psychiatrists need extra training to prescribe clozaril..not a good comparison. I ordered a lipid panel (pre zyprexa start), a CBC for a new pt on Depakote, and a testosterone level.....all today. If I see weird stuff I go to the PCP, if they are unsure they order more tests and get outside consultation. I am not a lone ranger, and it works very well. I am going back to my hole now..........Sam.

 

[Anasazi23]

We can argue to the end of time, and no matter what the end result is, you're trying to argue that psychologists know medicine like a physician. You'll say you're not, but the fact that you're arguing says you are. It's not the same. Disease process that are non-psychiatrically related are known to psychiatrists.

It's not an attribution error, since your grad school experience simply isn't med school. They're clearly completely variables.


Doc Samson is right in his post above. Everything is out of context and cookbook. That's crap medicine. Much like how an NP practices.

 

[Solideliquid]

Even great psychiatrists need extra training to prescribe clozaril..not a good comparison. I ordered a lipid panel (pre zyprexa start), a CBC for a new pt on Depakote, and a testosterone level.....all today. If I see weird stuff I go to the PCP, if they are unsure they order more tests and get outside consultation. I am not a lone ranger, and it works very well. I am going back to my hole now..........Sam.

We get the training during residency.

 

[Anasazi23]

Even great psychiatrists need extra training to prescribe clozaril..not a good comparison.

Huh?

That's run-of-the-mill standard for us.
I did it twice today.

 

[50960]

In ca. psychiatrists have to be specially registered to use clozaril, and most stay away from it.

 

[Doc Samson]

Even great psychiatrists need extra training to prescribe clozaril..not a good comparison.

No, we don't, it's part of residency training. And it's not something to be avoided either, it's a valuable treatment. The only medication we need extra training to prescribe is buprenorphine for the outpatient treatment of opiate addiction.

 

[Doc Samson]

The point is, it is happening.

So is child abuse... doesn't make it right.

 

[Doc Samson]

If I see weird stuff I go to the PCP, if they are unsure they order more tests and get outside consultation. I am not a lone ranger, and it works very well. I am going back to my hole now..........Sam.

This is my point exactly. "weird stuff" to you, is interpretable data to us. "Going to the PCP" is an extra, unecessary step that adds extra, unecessary opportunity for error. As physicians, we are obliged to provide treatments that offer the greatest possible good weighed against the least possible harm for our patients. In that equation, I cannot believe that the good offered by psychologist prescribing is outweighed by the increased risk of harm.

 

[Anasazi23]

In ca. psychiatrists have to be specially registered to use clozaril, and most stay away from it.

Just FYI, all psychiatrists must register with Clozaril through the prescription access system. Or you could actually be not registered but a so-called "covering physician."

Patients must then also be registered, have blood drawn, then approved by the pharmacy prior to dispensing.

The paperwork takes 5 minutes to register, really. I'm not sure why they would avoid it. I've never heard of a psychiatrist doing this.

 

[Doc Samson]

Moreover, during specialization practitioners pursuing these privileges will learn much of the clinical physiology needed to prescribe these medications effectively.

Well, to learn the clinical physiology needed to prescribe safely took me all of medical school, and probably most of internship. 3rd year medical students can't prescribe, and they have significantly more medical education than is proposed for psychologist prescribers.

While every single possible disease entity is not covered in medical school, we are trained to think systemically. I might not be able to make the exact diagnosis of a rare tropical disease, but I could probably narrow it down to "an infectious process."

 

[Psyclops]

We can argue to the end of time, and no matter what the end result is, you're trying to argue that psychologists know medicine like a physician. You'll say you're not, but the fact that you're arguing says you are. It's not the same. Disease process that are non-psychiatrically related are known to psychiatrists.

See, I don't think those psychologists seeking RxP are arguing this. I think they are merely arguing taht it can be done safely and effectively to a certain extent. They aren't asking for the right to to prescribe tamoxifen to treat cancer, or AZT to treat aids. I think the privileges sought are small in scope. The majority of patients, especailly on an outpatient basis, don't present with wildly abnormal labs. I think many psychologists are asking for the training (and to be compensated for their expertise) in being able to better understand the medication that many of their patients are allready being prescribed, and an ability to monitor that.

Of course there will be PhDs out there who don't have the best interest of clients at heart. They want the Rxp formore money or power or whatever. But I feel that the vast majority will take the inch and be happy with it. They aren't going to ask for the mile. If things seem to be beyond their expertise they will pass it along to the MD. But by in large, I don't think someone needs the expertise of an MD to begin and for med checks of many of these psychotropics.

And going to med school isn't a gurantee that you will practice safe and efective medicine. I've seen kids as young as five come into the hospital on 150mg QD of Lithium. WTF? Bipolar? Give me a break. Or 14 year olds with sever cases of akinisia. But aside from the occasional accusatory post on this forum I don't think that we should do away with psychiatry.

 

[Psyclops]

Dear Psychiatrists,

I've started a thread on the psychology forum about DID. I'd love it if you guys would weigh in, and share your opinions/knowledge on the subject.

 

[Doc Samson]

And going to med school isn't a gurantee that you will practice safe and efective medicine. I've seen kids as young as five come into the hospital on 150mg QD of Lithium. WTF? Bipolar? Give me a break. Or 14 year olds with sever cases of akinisia. But aside from the occasional accusatory post on this forum I don't think that we should do away with psychiatry.

I know an awful lot of very well trained child psychiatrists that diagnose and treat bipolar DO in childhood. I don't claim to know the evidence, since I'm not trained in child psychiatry, but I have no reason to doubt my colleagues that are.

 

[Doc Samson]

See, I don't think those psychologists seeking RxP are arguing this. I think they are merely arguing taht it can be done safely and effectively to a certain extent. They aren't asking for the right to to prescribe tamoxifen to treat cancer, or AZT to treat aids. I think the privileges sought are small in scope. The majority of patients, especailly on an outpatient basis, don't present with wildly abnormal labs. I think many psychologists are asking for the training (and to be compensated for their expertise) in being able to better understand the medication that many of their patients are allready being prescribed, and an ability to monitor that.

This argument smacks of anti-mental-illness bias. Prescribing psychiatric medications is "easy", but antineoplastic or antivirals is "hard." Honestly, I think it's the other way around, once the diagnosis is made, meds for CA of HIV are pretty much a plug-and-chug proposal.

 

[Psyclops]

This argument smacks of anti-mental-illness bias. Prescribing psychiatric medications is "easy", but antineoplastic or antivirals is "hard." Honestly, I think it's the other way around, once the diagnosis is made, meds for CA of HIV are pretty much a plug-and-chug proposal.

This is a good point, I didn't eman it to be anti-mental illness bias, I was innefectively trying to show that psychologsits weren't trying to get to prescribe everything. But I do think that for many cases prescribing is relatively straight forward.

 

[Anasazi23]

This is a good point, I didn't eman it to be anti-mental illness bias, I was innefectively trying to show that psychologsits weren't trying to get to prescribe everything. But I do think that for many cases prescribing is relatively straight forward.

They've already proposed further bills in NM and LA demanding more rights, larger formularies, with less to no supervision, to treat systemic diseases.

They're not happy with the inch.

 

[Psyclops]

They've already proposed further bills in NM and LA demanding more rights, larger formularies, with less to no supervision, to treat systemic diseases.

They're not happy with the inch.

Well then I give up...


I don't think it's as big of a threat as the MDs make it out to be, and I don't think it's as attractive a feature as those pursing it seem to either. If I amy be elitest, I think psychologists should spend their time doing research and assessment/testing.