Well...I rx'd my first cat today

[Nasrudin]

There are those "firsts" in training, that, once accomplished, make you feel like you're really learning the art and craft of this thing.

And I just want to thank everyone. My mother. Mrs. Garrot, my 9th grade lit teacher. My basketball coach who walked out of the lockeroom after our 0-9 season, never to be seen again. My boss on a construction site who told me I was a **** carpenter and that I should go make a living talking to people...well I did.

It's just an amazing feeling that society has tasked me with rx-ing animals. No Sarcasm. I f'n wrote a rx for a cat today. And felt great about it.

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[clausewitz2]

There are those "firsts" in training, that, once accomplished, make you feel like you're really learning the art and craft of this thing.

And I just want to thank everyone. My mother. Mrs. Garrot, my 9th grade lit teacher. My basketball coach who walked out of the lockeroom after our 0-9 season, never to be seen again. My boss on a construction site who told me I was a **** carpenter and that I should go make a living talking to people...well I did.

It's just an amazing feeling that society has tasked me with rx-ing animals. No Sarcasm. I f'n wrote a rx for a cat today. And felt great about it.

Mazel tov.

 

[TheFuture_22]

There are those "firsts" in training, that, once accomplished, make you feel like you're really learning the art and craft of this thing.

And I just want to thank everyone. My mother. Mrs. Garrot, my 9th grade lit teacher. My basketball coach who walked out of the lockeroom after our 0-9 season, never to be seen again. My boss on a construction site who told me I was a **** carpenter and that I should go make a living talking to people...well I did.

It's just an amazing feeling that society has tasked me with rx-ing animals. No Sarcasm. I f'n wrote a rx for a cat today. And felt great about it.

Should be an XBOX achievement.


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[F0nzie]

Fur real? You've got to be kitten me.


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[Shikima]

Fur real? You've got to be kitten me.


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[deleted314290]

Poor cat.

 

[clozareal]

I want some clarification: Did you write a prescription for a cat to take a medication, or did you prescribe a cat as a support animal to a human patient?

 

[birchswing]

I'm pretty sure the OP meant he or she suggested a cat. My PCP has written a picture of sunshine on a prescription pad before (meaning go out in the sun). He's also been pushing me to get a new dog after my dog of 19 years recently passed away. He noticed an increase in my health concerns and anxiety corresponding with the timing of his death. It's nice when people notice things like that and make a bigger picture connection that you might not see.

 

[Merovinge]

There are those "firsts" in training, that, once accomplished, make you feel like you're really learning the art and craft of this thing.

And I just want to thank everyone. My mother. Mrs. Garrot, my 9th grade lit teacher. My basketball coach who walked out of the lockeroom after our 0-9 season, never to be seen again. My boss on a construction site who told me I was a **** carpenter and that I should go make a living talking to people...well I did.

It's just an amazing feeling that society has tasked me with rx-ing animals. No Sarcasm. I f'n wrote a rx for a cat today. And felt great about it.

I just found out that a community CAP kept a "therapy cat" in her office for all her appointments. Sadly, her practice skills were even worse than that decision.

 

[Shikima]

Fur real? You've got to be kitten me.


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[PsyDr]

I'm sure you wrote that under the FHA, because you knew that the ADA does not approve cats as service animals. And spent a great deal of time educating the patient about the differences between the two laws.

 

[Nasrudin]

The aforementioned cat--whom I will, in the interest of confidentiality--call Sally.

She is a rotund, sedate creature with an indifferent affect. But for whom, despite this, her owner, my other client, had, in demonstration of considerable sequential step-wise effort--for which she struggles with typically--obtained official certification from the ..... uh.... appropriate authorities on the matter--for Sally to be identified, by me surprisingly... to be fit for therapeutic service to my other client. But, apparently, said authorities have indicated a Rx is required to then have Sally, on hand, to perform prn therapy for my other client. This Rx is then required to be revealed to .... uh.... anyone who would be in a position to require proof of the feline's therapeutic occupation.

It's an interesting question....is this fair to the cat?

 

[Nasrudin]

I'm sure you wrote that under the FHA, because you knew that the ADA does not approve cats as service animals. And spent a great deal of time educating the patient about the differences between the two laws.

Wait .... whuhhh....?

Haha. No. I left the forensic question out of it. Asking that the cat be allowed to remain in the client's company.

My EMR couldn't compute. I couldn't figure out how many refills to put.

I liked being in the funny predicament. But no....like many things in training, I just starting making it up as I'm going along.

 

[PsyDr]

Wait .... whuhhh....?

Haha. No. I left the forensic question out of it. Asking that the cat be allowed to remain in the client's company.

My EMR couldn't compute. I couldn't figure out how many refills to put.

I liked being in the funny predicament. But no....like many things in training, I just starting making it up as I'm going along.

Unfortunately, you have unknowingly opined on a forensic issue (i.e., ADA). And you have done so in a manner that is contradicted by the ADA. Taking a cat to a treatment facility or clinic is not covered by any federal law. A cat cannot be a service animal under the ADA. You have opined that it can. So what happens when an astute person tells your patient to get the F out with the cat? They would be 100% correct. What happens if the patient tries to file a suit for perceived damages for being embarrassed or "discriminated" upon? Whose to blame? The person who supported federal law? The person who gave advice that contradicted federal law?

I'm not trying to be a jerk here, but one should probably read the ADA and FHA and understand the differences before giving opinions.

 

[Nasrudin]

Hmmm.

How about I stay secure in the position that if some relief of sx is achieved by the presence of the cat then I support it.

On the other hand if the law states otherwise then fine, don't allow it.

I could care less either way. The reason being, is that I see the law as taking precedence over the notion that maybe the cat might be useful.

I wrote the Rx as a question--Please allow this person the company of their animal which has been certified to have the status as an emotional support animal.

If you write rx's then you know, that you're not guaranteeing an effect, you're Rx-ing, hoping to achieve an effect.

The way I see it, is, I'm identifying a potential benefit: if the law says otherwise then, fine. Don't let this cat on a plane, or whatever...

 

[splik]

Unfortunately, you have unknowingly opined on a forensic issue (i.e., ADA). And you have done so in a manner that is contradicted by the ADA. Taking a cat to a treatment facility or clinic is not covered by any federal law. A cat cannot be a service animal under the ADA. You have opined that it can. So what happens when an astute person tells your patient to get the F out with the cat? They would be 100% correct. What happens if the patient tries to file a suit for perceived damages for being embarrassed or "discriminated" upon? Whose to blame? The person who supported federal law? The person who gave advice that contradicted federal law?

I'm not trying to be a jerk here, but one should probably read the ADA and FHA and understand the differences before giving opinions.

he never mentioned anything about the ADA, service animals or anything. he just said he rx'd a f***in cat (though technically he did not actually prescribe a cat just affirm the therapeutic value of this puss for its owner). This has nothing to do with the law. As for liability issues, there is almost zero liability attached to expressing opinions made with reasonable care and professional judgment. It is exceptionally rare for even forensic psychiatrists to be sued successfully for expressing an opinion

 

[Ceke2002]

I'm pretty sure the OP meant he or she suggested a cat. My PCP has written a picture of sunshine on a prescription pad before (meaning go out in the sun). He's also been pushing me to get a new dog after my dog of 19 years recently passed away. He noticed an increase in my health concerns and anxiety corresponding with the timing of his death. It's nice when people notice things like that and make a bigger picture connection that you might not see.

That's what I thought initially as well, but further reading makes it sound like this patient already has a cat and wants the cat certified as a therapy animal that can accompany her places. Not sure how I feel about that, the cat would have to have a very particular temperament for that to even be remotely feasible. I'm sorry to hear you about your dog as well, 19 is an amazing age to have achieved for a canine though, you obviously looked after him very well.

 

[birchswing]

I have a cardiologist who kept a cat in his office (it passed away a couple years ago).

The first time I saw the cat was when I was waiting for the doctor with the door ajar, and he walked into the office and then right back out, I actually thought I was having a hallucination for the first time. But turned out there really was a cat in the office. Was quite weird.

That's what I thought initially as well, but further reading makes it sound like this patient already has a cat and wants the cat certified as a therapy animal that can accompany her places. Not sure how I feel about that, the cat would have to have a very particular temperament for that to even be remotely feasible. I'm sorry to hear you about your dog as well, 19 is an amazing age to have achieved for a canine though, you obviously looked after him very well.

Thank you very much. Well, we were very fortunate with him. He was an amazing dog. Very healthy throughout his life and a very easy dog to have. Was happy to do anything or nothing at all. I took good care of him but my parents did, as well. He was with me through a lot.

 

[OldPsychDoc]

he never mentioned anything about the ADA, service animals or anything. he just said he rx'd a f***in cat (though technically he did not actually prescribe a cat just affirm the therapeutic value of this puss for its owner). This has nothing to do with the law. As for liability issues, there is almost zero liability attached to expressing opinions made with reasonable care and professional judgment. It is exceptionally rare for even forensic psychiatrists to be sued successfully for expressing an opinion

Has the indiscriminate prescribing of emotional support animals (or the failure to do so) resulted in any lawsuits yet?
I'd love to read about it...

 

[Shikima]

Why even bother to ask doctors for such letters. Let the lawyers battle this one out in court and make a judge sign a paper.

 

[Ceke2002]

I just found out that a community CAP kept a "therapy cat" in her office for all her appointments. Sadly, her practice skills were even worse than that decision.

As much as I would love for my Psychiatrist's office to contain a cat, I'm afraid it would mean not much therapy was actually achieved, and he might find it difficult to end appointments with me on time. Although I'm secretly hoping he'll surprise me with a box of kittens for our last ever session (hmm, that'll be around June this year, maybe I should start dropping hints now )

 

[clausewitz2]

Why even bother to ask doctors for such letters. Let the lawyers battle this one out in court and make a judge sign a paper.

Our system wide policy is that we are not allowed to ask why someone has a support animal. We are only allowed to ask if there are any tasks it has been trained to perform. This means that when people show up on our psych ED with their support lizard, we are not actually allowed to ask why they have such a thing.

This is just as stupid in practice as it sounds. We don't have to let them take a support animal into our units, but still. Service animals we probably would have to, and I have no idea what the relevant case law says , but our legal department says that only dogs and miniature horses can count as true service animals.

 

[Ceke2002]

Our system wide policy is that we are not allowed to ask why someone has a support animal. We are only allowed to ask if there are any tasks it has been trained to perform. This means that when people show up on our psych ED with their support lizard, we are not actually allowed to ask why they have such a thing.

This is just as stupid in practice as it sounds. We don't have to let them take a support animal into our units, but still. Service animals we probably would have to, and I have no idea what the relevant case law says , but our legal department says that only dogs and miniature horses can count as true service animals.

I have to agree with the sentiment here. I find my cats to be incredibly therapeutic, and I've literally not been without a cat by my side for anymore than 6 weeks for the past 44+ years of my life, but there is a huge difference between, "I love cats, owning cats is personally beneficial to my emotional welfare" and "Please allow me to strap a cat to me 24/7, because therapy animal'. Yeah, granted that was hyperbole to make a point, but an animal based therapy program where a group of professional animal handlers might visit a treatment facility, or a care home with a cat, or a dog, or a lizard, snake, whatever, and allow patients a couple of hours with that animal is vastly different, in my mind at least between letting said animals remain with their owners whilst in short term care at least.

I still want a box of kittens for my final therapy session though.

 

[Shikima]

I need a therapeutic pet Allosaurus.

 

[PsyDr]

he never mentioned anything about the ADA, service animals or anything. he just said he rx'd a f***in cat (though technically he did not actually prescribe a cat just affirm the therapeutic value of this puss for its owner). This has nothing to do with the law. As for liability issues, there is almost zero liability attached to expressing opinions made with reasonable care and professional judgment. It is exceptionally rare for even forensic psychiatrists to be sued successfully for expressing an opinion

Oh but he did. I'm sure you are aware of jcaho regs, state laws, etc which prohibit animals in treatment facilities, clinics, places where food is served (which can be defined as minimally as ice in some states), etc.

OP pointed out that he prescribed that this patient be allowed to take their cat to a therapy appointment. Since this is a healthcare facility, both federal and state laws apply. So what's the law that exempts a person from federal law? It's the damn ADA. Which solely defines service animals as dogs or mini horses. I'm sure OP is aware there is no such thing as therapy animals in the ADA, and that that's only a FHA thing, and can define the setting in which they apply including the number of units in a private apartment.

Even if you think there is no liability, don't you think one should have read or received some minimal education in the area in which they are practicing?

 

[Shikima]

The only place it matters is in court.

 

[justfolks]

Not a psychiatrist, just a patient but also a lawyer, thought some clarification might be helpful for anyone who is interested in the legal issue (which may be no one!). To be clear, the Fair Housing Act applies to housing, the Americans with Disabilities Act applies to public life, and both contemplate that certain types of service animals must be accommodated in specified contexts (housing, the workplace, restaurants, etc.). For example, the ADA provides:

§ 35.136 Service animals

• (a) General. Generally, a public entity shall modify its policies, practices, or procedures to permit the use of a service animal by an individual with a disability.
• (b) Exceptions. A public entity may ask an individual with a disability to remove a service animal from the premises if—
  • (1) The animal is out of control and the animal's handler does not take effective action to control it; or
  • (2) The animal is not housebroken.
• (c) If an animal is properly excluded. If a public entity properly excludes a service animal under § 35.136(b), it shall give the individual with a disability the opportunity to participate in the service, program, or activity without having the service animal on the premises.
• (d) Animal under handler's control. A service animal shall be under the control of its handler. A service animal shall have a harness, leash, or other tether, unless either the handler is unable because of a disability to use a harness, leash, or other tether, or the use of a harness, leash, or other tether would interfere with the service animal's safe, effective performance of work or tasks, in which case the service animal must be otherwise under the handler's control (e.g., voice control, signals, or other effective means).
• (e) Care or supervision. A public entity is not responsible for the care or supervision of a service animal.
• (f) Inquiries. A public entity shall not ask about the nature or extent of a person's disability, but may make two inquiries to determine whether an animal qualifies as a service animal. A public entity may ask if the animal is required because of a disability and what work or task the animal has been trained to perform. A public entity shall not require documentation, such as proof that the animal has been certified, trained, or licensed as a service animal. Generally, a public entity may not make these inquiries about a service animal when it is readily apparent that an animal is trained to do work or perform tasks for an individual with a disability (e.g., the dog is observed guiding an individual who is blind or has low vision, pulling a person's wheelchair, or providing assistance with stability or balance to an individual with an observable mobility disability).
• (g) Access to areas of a public entity. Individuals with disabilities shall be permitted to be accompanied by their service animals in all areas of a public entity's facilities where members of the public, participants in services, programs or activities, or invitees, as relevant, are allowed to go.
• (h) Surcharges. A public entity shall not ask or require an individual with a disability to pay a surcharge, even if people accompanied by pets are required to pay fees, or to comply with other requirements generally not applicable to people without pets. If a public entity normally charges individuals for the damage they cause, an individual with a disability may be charged for damage caused by his or her service animal.
• (i) Miniature horses.
  • (1) Reasonable modifications. A public entity shall make reasonable modifications in policies, practices, or procedures to permit the use of a miniature horse by an individual with a disability if the miniature horse has been individually trained to do work or perform tasks for the benefit of the individual with a disability.
  • (2) Assessment factors. In determining whether reasonable modifications in policies, practices, or procedures can be made to allow a miniature horse into a specific facility, a public entity shall consider—
    • (i) The type, size, and weight of the miniature horse and whether the facility can accommodate these features;
    • (ii) Whether the handler has sufficient control of the miniature horse;
    • (iii) Whether the miniature horse is housebroken; and
    • (iv) Whether the miniature horse's presence in a specific facility compromises legitimate safety requirements that are necessary for safe operation.
  • (3) Other requirements. Paragraphs 35.136 (c) through (h) of this section, which apply to service animals, shall also apply to miniature horses.

(Bolded emphasis added.)

The FHA and ADA, which are federal laws, are not the only laws that could apply to an emotional support animal -- local and state laws may require that emotional support animals (which are different from psychiatric service animals) be accommodated even if the FHA and ADA do not. I'm not aware of anything in the FHA and ADA that purports to restrict or bar the prescribing of an emotional support animal of whatever type -- cat, frog, whatever. The section of the ADA quoted above certainly doesn't say that. This makes sense, given that simply "prescribing" a cat for emotional support is not the same as purporting to require a restaurant or workplace or whatever to accommodate said cat -- they may or they may not, but no doctor can force them to do it if the law doesn't otherwise require it.

For those who are interested, the question of whether prescribing could result in liability if the animal bites someone (a different but somewhat related question) has been addressed here:

http://www.mdedge.com/currentpsychi...ement/could-rx-pet-therapy-come-back-bite-you

And you can read more about the topic of support animals generally, including various applicable laws, here:

http://www.disabilityrightsca.org/pubs/548301.pdf

Apologies for the lengthy post!

 

[Shikima]

Like I said, court.

 

[nancysinatra]

As with any prescription, I hope you asked about allergies first!

 

[nancysinatra]

OP pointed out that he prescribed that this patient be allowed to take their cat to a therapy appointment. Since this is a healthcare facility, both federal and state laws apply.

What makes you think the therapy appointment is occurring in a healthcare facility? Maybe it's happening at Starbucks. When I was doing telepsychiatry, I actually contemplated having my office there. The thing about telepsychiatry is, with each day you do it, the more you realize you can get away with anything. Don't feel like getting dressed? Hey, it's no problem. Working out of a Starbucks is the next logical step. I even had this idea for a backdrop I could purchase at a photo supply store, to make it look like I wasn't at Starbucks, but somewhere more serene and, importantly, confidential. Ok I didn't do it but I'm just saying.

I think "health care facility" is more a matter of zoning laws than anything else, right? We're not talking surgery, but therapy.

 

[PsyDr]

What makes you think the therapy appointment is occurring in a healthcare facility? Maybe it's happening at Starbucks. When I was doing telepsychiatry, I actually contemplated having my office there. The thing about telepsychiatry is, with each day you do it, the more you realize you can get away with anything. Don't feel like getting dressed? Hey, it's no problem. Working out of a Starbucks is the next logical step. I even had this idea for a backdrop I could purchase at a photo supply store, to make it look like I wasn't at Starbucks, but somewhere more serene and, importantly, confidential. Ok I didn't do it but I'm just saying.

I think "health care facility" is more a matter of zoning laws than anything else, right? We're not talking surgery, but therapy.

Well, if you were seeing cms patients working at Starbucks would violate a few laws. And most commercial insurance contracts that I've seen.

Healthcare facility may be a zoning issue in your particular area but that's relatively unimportant. Any and all healthcare settings are subject to federal law. there are specific federal laws which define where the healthcare setting is in the case of telemedicine, but I'm sure you read those regs. if the proposed patient was a cms covered individual, then seeing them at their home via telemedicine would be considered healthcare fraud because of the origination rules. But why healthcare setting =where patient is seen=federal laws apply is an easily studied story. This is why you have to opt out of Medicare even if you never signed up to see cms patients. Or why hippa applies. Or why ADA, HITEC, ryan hauihy, applies. Etc etc etc.

In 2015, the VA banned emotional support animals in their facilities.

I don't see why my suggesting that one should read the relevant laws applicable to the practice area is met with such opprobrium.

 

[nancysinatra]

Well, if you were seeing cms patients working at Starbucks would violate a few laws. And most commercial insurance contracts that I've seen.

Healthcare facility may be a zoning issue in your particular area but that's relatively unimportant. Any and all healthcare settings are subject to federal law. there are specific federal laws which define where the healthcare setting is in the case of telemedicine, but I'm sure you read those regs. if the proposed patient was a cms covered individual, then seeing them at their home via telemedicine would be considered healthcare fraud because of the origination rules. But why healthcare setting =where patient is seen=federal laws apply is an easily studied story. This is why you have to opt out of Medicare even if you never signed up to see cms patients. Or why hippa applies. Or why ADA, HITEC, ryan hauihy, applies. Etc etc etc.

In 2015, the VA banned emotional support animals in their facilities.

I don't see why my suggesting that one should read the relevant laws applicable to the practice area is met with such opprobrium.

Can you take a joke or not? Why would I say I was going to work in a Starbucks other than a joke? Same with the zoning comment. OMG some people on this forum need to get a sense of humor.

 

[nancysinatra]

To all the people who think it's a really important matter where this "therapy" takes place - earth to you guys - we are talking here about CATS. Cats, like our patients, will go wherever the h*** they want. They're ANIMALS.

By the way, I would like a therapy blue whale, and approval for a huge aquarium in my rental abode. This aquarium will need to be big enough for several boats and a beach about the size of Florida. In fact I think the government needs to approve my free housing right next to the beach. Can someone help me with this, preferably someone early in their training, without too great of job prospects yet, who takes themselves really seriously? Thank you. When it's all said and done I will give you a good reference.

 

[birchswing]

http://abcnews.go.com/Health/doctor...s-starbucks-defends-actions/story?id=20803865

 

[nancysinatra]

http://abcnews.go.com/Health/doctor...s-starbucks-defends-actions/story?id=20803865

The guy in the story was not providing psychotherapy at Starbucks. He was prescribing opiates. There's kind of a difference, you know.

Nonetheless the story has some good lines:

"That nightmare began in 2010, when Yee started examining patients at Starbucks. He said that he would pull out his stethoscope and listen to patients' hearts, lungs, evaluating all vital signs. Sometimes, he said, he even performed neurological exams."

Because, OMG, evaluating gait and station as someone walks to their table, and observing arm and back strength as they pick up their 5-pound zebra mochachino is so much more invasive than pulling out a stethoscope, reaching under someone's shirt, and listening to their heart and lungs right there in public. Not to mention getting a rectal temperature. It says he evaluated ALL vital signs.

"But the patients kept coming, one-third of them in their 20s. Some even asked for Adderall and Xanax."

In my experience, it would be all. But then, I haven't worked from Starbucks for all that long.

 

[birchswing]

The guy in the story was not providing psychotherapy at Starbucks. He was prescribing opiates. There's kind of a difference, you know.

Statements like this are why I and at least one other person didn't think your first statement on doing therapy out of Starbucks was a joke. You seem now to be defending therapy out of Starbucks. But then saying it's an obvious joke.

My point, however, wasn't to make any point at all. The conversation just reminded me of that story.

 

[splik]

Statements like this are why I and at least one other person didn't think your first statement on doing therapy out of Starbucks was a joke. You seem now to be defending therapy out of Starbucks. But then saying it's an obvious joke.

My point, however, wasn't to make any point at all. The conversation just reminded me of that story.

not that there is anything wrong with doing psychotherapy at starbucks. It is not uncommon for therapists and psychiatrists working with adolescents to meet in public places, particularly in other countries. because americans are more litigious I think its more risky to do this sort of thing (though case managers, recreational therapists, social skills trainers and others certainly do this). when i was a medical student in england we would take the psych patients for ice cream. here when i suggested it they looked like i had suggested buggering a goat.

 

[nancysinatra]

Statements like this are why I and at least one other person didn't think your first statement on doing therapy out of Starbucks was a joke. You seem now to be defending therapy out of Starbucks. But then saying it's an obvious joke.

My point, however, wasn't to make any point at all. The conversation just reminded me of that story.

I'd call my original comment ironic, and if you don't get it, I can't explain it. I'm sorry that life and humor are harder than that, and sometimes not just jokes, but ideas themselves require more than just "explanation" - they require the appreciation of irony or wit. I can't provide those qualities. But no, I am not "defending" therapy out of Starbucks. I'm sorry you don't get what I meant. Judging from what's being said about me in other forums, you're probably not the only one who does not. I apologize for that. Apparently my humor and attitude are not welcome here. I will go away if that is what people want.

 

[nancysinatra]

not that there is anything wrong with doing psychotherapy at starbucks. It is not uncommon for therapists and psychiatrists working with adolescents to meet in public places, particularly in other countries. because americans are more litigious I think its more risky to do this sort of thing (though case managers, recreational therapists, social skills trainers and others certainly do this). when i was a medical student in england we would take the psych patients for ice cream. here when i suggested it they looked like i had suggested buggering a goat.

You were a med student in England? No wonder you have such a broad perspective. Of course, that can come to harm you in this country, where, as you imply, litigiousness is the rule.

 

[birchswing]

I'd call my original comment ironic, and if you don't get it, I can't explain it. I'm sorry that life and humor are harder than that, and sometimes not just jokes, but ideas themselves require more than just "explanation" - they require the appreciation of irony or wit. I can't provide those qualities. But no, I am not "defending" therapy out of Starbucks. I'm sorry you don't get what I meant. Judging from what's being said about me in other forums, you're probably not the only one who does not. I apologize for that. Apparently my humor and attitude are not welcome here. I will go away if that is what people want.

No, no, please don't go. I'm just a visitor here. I often don't get irony.

To be honest, and maybe it's from my medications, I tend to respond to posts rather than people as I don't have a memory where I retain an association between posts and a user ID, with only a couple of exceptions. I remember who Ceke is of course because she's another patient and lives in Australia. That stands out. I remember OldPsychDoc because he was rather magnanimous toward me in letting me stay after my satire as novopsych. And I generally remember splik as being the one who tends to write out detailed, academic posts. With your user name, what I can remember the most about you is that you were in a position somewhere in the middle of the US and were not happy where you were and were trying to get out, as I recall. But I mostly don't have an association between user names and content, unless it's within a single thread and I'm scrolling back up to see who wrote what. I didn't know you were feeling unwanted by others, had not seen any other posts to that effect. To be honest, I was coming back thinking I would get a tongue-lashing for being so abrupt with you.

Now that I've jogged my memory, to the extent I can, how are things? Were you able to get out of the bad job situation you had?

 

[PsyDr]

Can you take a joke or not? Why would I say I was going to work in a Starbucks other than a joke? Same with the zoning comment. OMG some people on this forum need to get a sense of humor.

Look, I'm not trying to be a jerk. My initial reply was to indicate that OP might want to read up on the laws regarding emotional support animals and service animals before engaging in that practice because I have experience in the area. I didn't think this was earth shattering stuff.

Since my practice is well over 90% forensics, I have some tendency to consider legal stuff. I rarely post in the psychiatry forum, but the recent times I have was because I watched people here say that it was okay to live abroad while doing telemedicine, and I had material knowledge that this advice was in contrast to cms rules. I dunno about you, but if I can prevent someone from unknowingly committing a federal crime, I'd prefer to err on the side of caution.

 

[WisNeuro]

I think I have less of a problem on whether or not it is legal, and more of problem that it's mostly useless, and in some cases of "support animals," reinforcing maladaptive coping strategies.

 

[Nasrudin]

Look, I'm not trying to be a jerk. My initial reply was to indicate that OP might want to read up on the laws regarding emotional support animals and service animals before engaging in that practice because I have experience in the area. I didn't think this was earth shattering stuff.

Since my practice is well over 90% forensics, I have some tendency to consider legal stuff. I rarely post in the psychiatry forum, but the recent times I have was because I watched people here say that it was okay to live abroad while doing telemedicine, and I had material knowledge that this advice was in contrast to cms rules. I dunno about you, but if I can prevent someone from unknowingly committing a federal crime, I'd prefer to err on the side of caution.

That's fair criticism. I'm glad I jokingly brought it up. Because in doing so, I realized I was thinking of the Rx in the traditional model of AE/benefit assessment with regards to the individual. I hadn't planned on being in the cat Rx business. So I applied my usual frame of mind to a novel situation. Which, I think is fair to criticize, in retrospect.

I thought of, first do no harm. And couldn't see the harm to the individual after discussing with her, if she was prepared to be the "lady with the cat on the train" and to bear that association in the minds of others. She resolutely affirmed the reduction of anxiety and agoraphobia from being able to stroke her companion. So... I wrote the Rx. Thinking only while reading this thread, about the potential for the spread of toxoplasmosis to a pregnant lady or something like that. Or the legalities of animal rx's in general.

I'll read the documents before rx-ing my next one.

But right now, I'm scrambling to learn therapy techniques. This is a low priority.

I think as a non-rx'er or possibly as a psychologist--i'm not sure--it's impossible for you to realize how many novel rx-ing situations we're placed in, in which supervision after the fact is a best-case scenario. Like this one for example. Of which I appreciate your supervision on.

 

[WisNeuro]

In essence, this is similar to what I see in many PTSD "support animals" that are trained to engage in checking behaviors, in it's ability to reinforce and perpetuate the anxiety. You've just replaced a benzo with an animal. Granted, it's s safety cue with (usually) fewer side effects, but it's a safety cue nonetheless. One that they will likely be unwilling to do without and make them more unlikely to engage in treatments that can actually address the root of the problem. I get the desire to help people, but in many of these cases of emotional support animals, I think we are doing the patients more harm than good.

 

[Therapist4Chnge]

My EMR couldn't compute. I couldn't figure out how many refills to put.

Do you know how many of the 9 lives were already used?

While some cats are quite safe, others are much more hazardous and some can even be addicting. There may be a limit on how many cats can be prescribed, as too many can really cause personal and profession problems.

Have you run a query on the P.A.W.S (Pet Access Writing System)? You want to make sure that the patient isn't doctor cat 'script shopping.

 

[Therapist4Chnge]

...but our legal department says that only dogs and miniature horses can count as true service animals.

I'm glad there are limits. I saw a picture of a llama flying on a plane the other day and was like…"Uh-huh. So that just happened." I would far rather a pot-bellied pig or half a dozen other animals if it were my choice, as llamas can be pretty mean and can spit indiscriminately if annoyed.

 

[PsyDr]

I'm glad there are limits. I saw a picture of a llama flying on a plane the other day and was like…"Uh-huh. So that just happened." I would far rather a pot-bellied pig or half a dozen other animals if it were my choice, as llamas can be pretty mean and can spit indiscriminately if annoyed.

That's another area of the law. That follows the federal rules of nondiscriminaition on the Basis of Disability in Air Travel, which allows emotional support animals so long as the passenger provides a letter from a licensed professional indicating that the animal is needed FOR AIR TRAVEL. Unusual animals like the stupid llama and duck photos can be excluded on the judgement of the air carrier if it will disrupt the passengers. Over 8 hr flights require statements that the animal will not need to relieve itself.

The problem with all these things is that service animal does not mean emotional support animal. Service animals can go almost anywhere. Emotional support animals can only go in specific types of housing or air carriage.