Clinical Psychology
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Oct 29, 2004
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From the American Psychiatric Association

A Patient's Perspective on Psychologist Prescribing
To the Editor: Contributors to the Patient Safety Forum in the December issue debated the contentious question of psychologist prescribing (1). In the hope that your readers are interested not only in the views of the two "warring factions" but also in those of patients, I am writing to offer my observations as a consumer of psychiatric services for more than 30 years.
A majority of prescriptions for antidepressants and anxiolytics are currently written by internists and general practitioners. These physicians are poorly trained to make initial psychiatric diagnoses and have little time for follow-up assessments. Few can remain current with the deluge of new research information pertaining to the myriad conditions they encounter on a daily basis, such as congestive heart failure, diabetes, dyslipidemia, and autoimmune diseases. Swamped by new information, internists and general practitioners are understandably susceptible to marketing messages from sales representatives hawking the latest minor modification to an antidepressant that is being touted as "an important clinical breakthrough."

Fortunately, serious errors in prescribing are nearly impossible in view of the fact that the similarities between the leading drugs to treat depression and anxiety disorders vastly exceed their relatively trivial differences. Indeed, the most serious treatment errors made by internists and general practitioners in this area are apt to be overlooking the value of psychotherapy or selecting a new branded drug when a generic would do. The homogeneity among these classes of drugs also enormously simplifies prescribing for psychologists. Furthermore, because psychologists are unlikely to be high-volume prescribers, they would attract fewer visits from sales representatives offering "information" and drug samples that may improperly influence treatment selection.

Dr. Scully makes the point that "many nonpsychiatric illnesses cause or worsen psychiatric symptoms ... [including] endocrine disorders, diabetes, malignancies, heart disease, and infections." The implication is that psychologists would likely overlook these problems. I have been treated by six psychiatrists during my years of experiencing depression and anxiety, and none has yet suggested that drug therapy be preceded by a battery of tests to detect any occult illness. These psychiatrists were all board certified; two were from the National Institute of Mental Health, and one was the former medical director of a large psychiatric hospital. Clearly, precious little in the way of medical triaging is being offered in psychiatrists' offices—most likely because it simply is not necessary.

Until there are meaningful clinical differences between drugs used to treat the most common psychiatric disorders, or an accurate way to predict patients' responses to the drugs, psychologists who are well trained in basic psychopharmacology are likely to offer pharmacologic care of equal or higher quality than that offered by general practitioners and internists. Indeed, psychologists' awareness of the added scrutiny that their treatment selections may attract is apt to foster a far more circumspect approach to prescribing—and a willingness to make referrals to specialists—than prevails in the current system.

It is time that professionals set aside their claims about who "cares more" about patients' welfare and instead allow progress in clinical care to supersede petty turf battles.

John S. Ensign, M.P.H.


Mr. Ensign, who lives in Shirley, Massachusetts, was formerly a public health advisor at the U.S. Food and Drug Administration. He is currently employed as an independent pharmaceutical market analyst.


Should psychologists have prescribing authority? Psychiatric Services 55:1420–1426, 2004


I guess this is the final word. After all, this guy is chronic psychiatric patient who also happens to have a master's degree in public health.

It's the final word if you ignore the fact that Mr. Ensign is trained neither in clinical psychology or psychiatry, not to mention pharmacology. Let's also ignore his n=1, which fails to note whether his case is representative of the - millions? - of psychiatric patients who may or may not have appropriate Axis III diagnoses. Let's also ignore the fact the the "market forces" that are clearly victimizing primary care physicians will not be absent from the offices of prescribing psychologists. Or how about the increasing homogeneity of drugs that will ease the workload on psychologists but seems to add confusion to the PCP's? Amusingly, he invokes the Hawthorne Effect as evidence that newly minted psychologist/prescribers will result in more thoughtful consideration of treatment options.

Give me a break.


10+ Year Member
Aug 20, 2004
Climb down from your throne..nobody claimed it was anything more than an FYI piece from a patient's perspective!! Some people are soooo touchy!! :D


Senior Member
10+ Year Member
7+ Year Member
Aug 14, 2004
"After all, this guy is chronic psychiatric patient who also happens to have a master's degree in public health."

Are you a psychiatrist or pre-psychiatry? Do all psychiatrists have this level of respect for their patients? Hm.


PsychMode said:
Are you a psychiatrist or pre-psychiatry? Do all psychiatrists have this level of respect for their patients? Hm.
Do all psychologists resort to an argument ad hominem in the face of data that doesn't support their conclusions? Hm.