when to refer or consult

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psych101

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Psychiatrists: When, if ever, in your practice do you find it helpful to consult with or refer a patient to a psychologist? Also interested in hearing and understanding the viewpoint of anyone who believes that a psychologist's services are either subpar, redundant, or otherwise unnecessary. To keep this discussion more focused, I'm not speaking about the debate about psychologists with Rx privileges -- I think medication issues should always be treated by a psychiatrist. I'm curious about cases in general and when or if you find it helpful to consult, and why or why not.
 
psych101 said:
Psychiatrists: When, if ever, in your practice do you find it helpful to consult with or refer a patient to a psychologist? Also interested in hearing and understanding the viewpoint of anyone who believes that a psychologist's services are either subpar, redundant, or otherwise unnecessary. To keep this discussion more focused, I'm not speaking about the debate about psychologists with Rx privileges -- I think medication issues should always be treated by a psychiatrist. I'm curious about cases in general and when or if you find it helpful to consult, and why or why not.

I am not sure when I would refer to a psychologist from a private practice setting, unless the patient was being seen in a psych unit, and originally had seen a psychologist.

I would like to see psychologists working in a PA capacity in a psychiatry private practice, for example. That was the setup when I did my outpatient psych elective. We had two psychiatrists, and four masters level psychologist. The psychiatrists would normally do the initial assessment and the follow-up appointment would be taken by one of the psychologists. The point of this was that if the patient called needed something and the psychiatrist was busy the psychologist would be familiar with the case and so on.

Psychologist can work independantly, but when they are in a hospital setting with medical issues they should be overseen by a physician.
 
Jon Snow said:
Heh. There's no such thing as a masters level psychologist. That whole post is warped, dude.


As usuall you have nothing constructive to add.

So what there are no masters level psychologists? I guess you can call them psychiatric nurse practitioner, as they had the RN, but also a MS and CNS.
 
psych101 said:
Psychiatrists: When, if ever, in your practice do you find it helpful to consult with or refer a patient to a psychologist? Also interested in hearing and understanding the viewpoint of anyone who believes that a psychologist's services are either subpar, redundant, or otherwise unnecessary. To keep this discussion more focused, I'm not speaking about the debate about psychologists with Rx privileges -- I think medication issues should always be treated by a psychiatrist. I'm curious about cases in general and when or if you find it helpful to consult, and why or why not.

Just to try to get back to the original intent... 🙄

1) specialized testing--IQ, neuropsych, etc.
2) specialized therapy. One of the best attendings in my residency program was a psychologist and a phenomenal cognitive-behavioral therapist. I REALLY wish I had a guy like him to refer to where I am now. I've got access to good general therapists (mostly master's level, MSWs, etc.), but no one like him who would do OCD exposures, panic desensitizations, etc....
 
I'll probably employ a psychologist for testing and 3-4 master level therapists for case management, cbt, dbt, et cetera. I guess you could call that consultation.
 
psisci said:
put em on a plane!!! 😱

Employ a psychologist.......good luck. :laugh:


Good point, I won't really need a full time psychologist. I'll farm it out as independent contractor work. I won't have to spring for benefits that way.
 
It's quite common in NY for psychiatrists to employ psychologists to work for them in their practice. They are usually given an office to conduct therapy and testing, and the psychiatrist takes a percentage.

In the case I'm most familiar with, the psychologist was paid quite well.

Nothing wrong with that really. I thought many psychologists had difficulty finding good stable positions. Wouldn't this be a welcome thing?
 
It is a business model that works very well in my region, and there is certainly no shortage of labor.

I'm not quite sure why that would cause so much anguish, as it integrates the care for the patient. Wasn't that the point of this thread? Just picture it. Psychiatrists, Psychologists and MSWs working together in veritable mental health utopia.
 
Yes, that was what I was curious about. I wondered how many psychiatrists saw the value in collaborating with psychologists for a number of reasons -- a thorough assessment/testing with quality recommendations, intensive or specialized forms of therapy (which our training typically focuses heavily on), an appreciation of empirically-based findings and research-based treatment, a focus on behavioral change perhaps even without a medication trial, etc. I wondered whether some psychiatrists feel completely capable of wholly treating the patient (assessment, meds, therapy) or if anyone would entertain the idea that something might fall outside the scope of their expertise and then seek an appropriate consult (and, if so, when this would happen). I am gathering that, although some psychiatrists see the value of working with other disciplines, others (perhaps because of lack of exposure or explanation about the value of doing so) don't see the value in collaborating. It is a shame, because multi-disciplinary teams, or at least consulting with professionals from other disciplines, can be extremely beneficial for the patient. I am sorry for anyone who views psychologists as your "helpers" with training on par of PAs or Social Workers (although they also serve in very helpful roles) who exist to do some dirty work you request (obtain a social history, come up with an IQ score, etc.). I hope that you have the opportunity to work with a good psychologist (because there are certainly bad ones) and see the benefit of doing so -- for you and the patient.
 
I saw a patient last night as what sounded like a more urgent consult.

I recommended no medications and intensive outpatient therapy. The story is somewhat convoluted, and she has and would benefit from particular medications, but at this stage, thought it more prudent for her to receive some specialized therapy (eating disorder issue), with re-initiation of meds sometime after that.

I know psychologists probably think that psychiatrists only dish out medications to everyone they see. However, this a stereotype in my experience...though of course it depends on the psychiatrist in question.
 
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