Thursday, January 20, 2005

Psychologist Prescribing

I was looking through some old journals and found this letter in the October 2004 Clinical Psychiatry News:
I continue to be amazed that psychiatrists are so up in arms about having psychologists prescribe medications after added training in psychopharmacology (“Prescribing Law in Louisiana Rankles Psychiatrists,” July 2004, p. 1 ).
We have no one to blame but ourselves. For years we have been content to give away our reflex hammers and stethoscopes for a prescription pad, and now we wonder why we are not heard when we invoke that we are medical doctors. We now even claim that monitoring blood work on atypical antipsychotics puts us in the domain of primary care. I teach residents who all too soon forget the basics of medicine and then feel uncomfortable about treating even simple medical problems.
Before we become more defensive, maybe we need to look at our own houses first. Why not reintroduce the 1-year medicine requirement into our residencies and continue to make our residents and attendings handle medical problems in their patients? If we do this, then we can state that we are qualified to prescribe where psychologists are not. Until then, we will continue to lose one state after another and we will have only one another to blame.
John Norton, M.D.Jackson, Miss.-->

The letter was written by one of my colleagues, a neurologist/psychiatrist at the U of MS Medical Center. I agree with him that psychiatry residents need more internal medicine training. I think that an ideal internship for neurology and psychiatry interns would consist of 8 months of internal medicine, 2 months of neurology, and 2 months of psychiatry. Currently most psychiatry interns only receive 4 months of internal medicine experience during their internship.


The Mad Doctor said...

What you say makes sense. I remember astonishment in the ER when the nurse told me she had never seen a psychiatrist perform a physical exam.

But that hardly makes a case for psychologists prescribing. They have no real science background as undergrads and little in grad school.

In my experience the psychologists wanting this power are those that are lousy psychologists. It is a political issue to them. The good ones have no interest in such matters and feel unqualified. I personally feel the same way about myself performing surgery which I have much more legitimate background to do than a psychologist prescribing.

Psychology as a profession suffers from a lack of specific things to offer. Most do therapy which is easy for all sorts of therapist designations to cut in on the territory. They need to find more niches to use their skills and intelligence. Mental health is too focused on medication anyways.

Michael Rack, MD said...

Mad Doctor, I agree with you. However, one type of psychologist that I have found very helpful to collaborate with is a neuropsychologist. Neuropsychological testing can be very helpful in distinguishing between the different types of dementia and in planning rehab after a traumatic brain injury. I haven't found other types of psychological testing, such as the MMPI-2, too helpful in the care of my patients.
Also, I wanted to clarify that I am 100% against psychologist prescribing.

Michael Rack, MD said...

Mad Doctor, I agree with you for the most part. One unique service that psychologists provide is psychological testing. I have found neuropsychological testing to be helpful in the assessment of certain patients with cognitive disorders.
Also, I wanted to clarify that I am 100% against psychologist prescribing.

Michael Rack, MD said...

Sorry about the 2 nearly identical comments; I was having a problem with posting the 1st comment and thought that it had been lost.

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