Prescription Privileges for Psychologists

Should Psychologists prescribe medications?

  • Yes. Why only doctors?

    Votes: 0 0.0%
  • Yes. But under even stricter qualifications.

    Votes: 0 0.0%
  • No.

    Votes: 0 0.0%
  • I don't know/care. Just give me the darn Prozac...

    Votes: 0 0.0%

  • Total voters
    0

Prof.Wizard

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Recent legislation in New Mexico will be allowing Px privileges to non-MD psychologists.

Personally, and against the medical community, I believe it's a good move if it's done; but under stricter qualifications and ONLY for those psychologists who specialize in Clinical Psychology with more-than-a-year qualified and MD-guided experience.

Psychology's magic, as the article says, lies in the ability to treat without using medication... It would be the end of this science to give psychologists the licence to act as limited Psychiatrists...
 

Mercutio

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In the US, Nurse Practicianers can also prescribe drugs already. There is a precedent.

Health care in the US is scary, scary, scary. We aren't a metric society here, and because of that, it's not uncommon for nurses to make measurement errors when dealing with medicines (which ARE measured in metric units).

Basically, I think the big push is to get antidepression drugs out to everyone. Not everyone wants to put up with psychiatric bullshit just to get his/her hands on some Zoloft. I know I don't, and I'm utterly aware that I'm someone who needs it.

By the same token, all a GP does in the US is prescribe general antibiotics and perform VERY minor procedures in his office. Nurses do all the real work (wrapping sprained ankles, most of the diagnostic work etc). The general-practice doctor, at this point, is a prescription-writing, referral-making babysitter for a bunch of nurses. Since drug companies can directly advertise to consumers in the US, it is very, very typical for a patient to come in DEMANDING a particular prescription medicine. Since most doctors get all kinds of kickbacks from drug companies (the medical school Amy goes to has a couple of sales reps basically ON SITE), they're only too happy to go alone. GPs might've had one rotation worth of Psych training. Maybe.

Think they kept up with the literature after that?

In the US there are a couple other classes of mental health professionals. There are Psychologists and also Clinical Social Workers. Both groups deal with far more of the day-to-day work in mental health, probably even more than psychiatrists, since "everyday" problems like depression, addiction and phobias are so common nowadays among nearly everyone, while the psychiatrist, by virtue of zero mental-health insurance availability, the "MD" after his name, and his ability to prescribe medication, has been either priced out of the market (his service is too expensive for most people) or put into a place where he is desperately needed, but accessible to the general public.
CSWs and Psychologists by-and-large read the same books and literature, follow the same trends in diagnosis and treatment (in theory, they don't make diagnosis, but is it so hard to recognize the DSM-IV symptoms for depression?), and unlike the psychiatrists (who, at this point, might as well be given a degree in neurobiology instead of an MD), are probably in closer contact with the afflictions we now have drugs to treat.

In short, other than the fact that Prozac will get handed out like Halloween candy or ritalin, I don't think it's a bad idea. Might even make the world a better place.
 

Will Rickards WT

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There is a real hassle when you pay good money to go to a psychologist and then have to see a psychiatrist just to get the Zoloft or Paxil or whatever it is you need. When you actually pay for you healthcare this means more than two office visits. Not only do you have to see the psychiatrist but every time you need a refill you need to see him. Thus she/he generates a revenue stream. Also the psychologist usually has policies that mean you have to see them every so often for a certain amount of time.

Seriously, once you are diagnosed with a chemical imbalance that requires chemical treatment, there shouldn't be all this crap just to get the meds. It should go on your record and your primary care doctor should just prescribe the stuff.

Rx is where the money is.... damn drug companies... sucking the lifeblood out of you... not providing cures just treatments.... it is a conspiracy I tell you!
 

Tea

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Actually, I am a rusted-on libiterarian. I think any adult citizen is entitled to whatever drug they choose. (Subject only to their ability to pay for it.) Prozac, asprin, heroin, cynaide, paint stripper, I don't care. If I want to take it, it is no-one's business but my own. If it's bad for me, so be it: it's my own stupid fault. Think of it as evolution in action.

But if we are going to continue with the current scheme, where you have to get someone else's permission to do things to your own self (a fundamental violation of your rights as a free citizen in a free country, but that's what we all put up with at present) then, sure, clinical psychologists are not fools. One-third of their "science" is baloney, and another third is wishful thinking, but that doesn't mean they are complete idiots. They get a lot of experience, a lot of hands-on knowledge, and no real university hands out a phD in Psychology to schoolboys. You can't even practice clinical psych at all without masters-level qualifications including two year's supervised practice, so we are not talking raw beginners here.

As a society, every year we are adding more and more special rules to give certain powerful interest groups more control over our lives. I'll give you a little example. (Prof will understand this, of course, others, well it depends on if you happen to be familiar with the particular condition.)

Tannin has psoriasis. Has had since he was in his mid-twenties. In the early days the doctors treated it with cortisone-based creams, which worked very well until they started having nasty side-effects. These days, it is recognised that using cortisone for mild to moderate psoriasis is like pruning your rose-bush with a chain-saw. Tannin and his doctor both decided at about the same time that this was not a good idea. A little later, the prescription-rules gurus decided that cortisone-based psoriasis treatments did more harm than good and took them off the list. (Except for extreme cases.)

But there are also two relatively benign substances that are commonly used to treat psoriasis. No-one really knows how they work - it is an astonishingly little understood condition when you remember that it affects about one seventh of the population.) The drug companies have a million different trade names for their various potions and lotions, but they all come down to either coal tar or dithrinol. In Tannin's case, the coal tar cremes do very little bar make a gooey, brown mess on his elbow (or whatever other spot is in question), but the dithranol-based ones work quite well for a little while.

Essentially, psoriasis is never cured, but you can make it go into remission sometimes, and if you succeed in that, the remission can last for years. To achieve this though, you have to be (a) lucky, and (b) very, very persistant with your treatment regime. Tannin doesn't try to achieve that with elbows and knees, but doesn't like it when it pops up on his face or hands, and tends to treat those fairly seriously. Up until about five years ago, all he had to do was walk into a chemist's shop (pharmacist in the US, I think) and buy some dithranol now and then, remember to use it twice a day, every day for perhaps two or three months till the spot dissapeared and a good month or two afterwards as well to make that particular place go right into remission.

But now, since about five years ago, the facist mongrels in Canberra have decided that dithranol is a prohibited substance, and can only be had on prescription. Tannin talked to a couple of pharmicists and a couple of doctors about this, and none of them could think of a good reason for the change. (Tannin could: it serves as yet another softly-softly extension of the power-base and swelling of the income stream of the virulent trade union called the AMA. But then, you see, Tannin's training is in the social sciences, so he is well-equipped to spot these things. Being naturally suspicious helps too.)

Net result: to treat a simple, non-life threatening condition, which he has had for 20 years and understands well, with a benign, effective substance with no known side effects, Tannin now has to:

* Make an appointment
* Take time off work
* Wait around for ages in the waiting room, getting bored stupid
* Pay quite a lot of money
* Go to the chemist and get the exact same tube of goo that he self-prescribed ten years ago.

And all of this to "consult" someone who knows a good deal less about Tannin's psoriasis than Tannin does himself!
 

Tea

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Yes Will: the druc companies spend an incredible amount developing and marketing psoriasis oitments that need to re-prescribed and re-prescribed, but there is hardly any basic research into a cure at all. No doubt it is the same with many other conditions.
 

Prof.Wizard

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Mercutio said:
Health care in the US is scary, scary, scary. We aren't a metric society here, and because of that, it's not uncommon for nurses to make measurement errors when dealing with medicines (which ARE measured in metric units).
The "MD" title isn't panacea for your health problems. But trust me, Merc, Medicine as practiced in the USA although costly is far better and more efficient (even if not so cost-effective) than many other parts of the world... Probably only the UK or some Scandinavian country has a better healthcare system.

Regarding the metric issue you wrote... hehe, it's quite the opposite of that in Germany's healthcare. There they are very cumbersome in their decisions as everything has to be written and according to the books.

The point of this discourse is, however, other: By giving Px (or Rx- although I think the first is more correct) privileges to Psychologists two things happen:
1st. Much more people will have access to psychotropic medicines and I'm afraid there will be a pharmaceutical approach to every daily problem. And this is really bad, considering today I saw in the news that the Yugoslav goverment banned the free access to anti-depressants because there has been an abuse after the bombings (stress period) for the people and many were addicted...
2nd. The science of Psychology is betraying its very essence. By studying the way in another (non-medical) way. Psychology's tools of trade have been psychoanalysis and psychotherapy... both can be done without anti-depressants and the like.

The first reason is very important. The second is more of an academic topic, but nevertheless I think it's pretty delicate because it will shape the practice of Psychology in the future.

BTW. I'm surprised nobody has voted so far a "NO"... Please read carefully the article and the above two reasons...
 

Prof.Wizard

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Errata on the 2nd reason:
...Psychology works by studying the brain in an alternative (non-medical) way. Psychology's tools of trade...
 

Mercutio

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In the US, a great many Psychiatrists couple drugs and a variety of other techniques with the same sort of theraputic techniques used by "lesser" mental health professionals.

At this point, from my understanding, a large chunk of what we consider treatable mental conditions come down to simply one form of chemical imbalance (decreased seratonin levels or somesuch) - exactly the sort of thing that we now know can be corrected with medication.

Assuming, of course, that you're willing to take them.

So, and again, this is just my understanding, much of the productive work a psychiatrist ends up doing is in figuring out which chemical imbalance needs to be treated, and what will restore that balance most effectively, with the fewest side effects. And that's fine.
So why bother with the therapy aspect? Psychiatrists - from personal enconuters - aren't given the quality of training in therapy that pyschologists are... the whole attitude is basically "let's fix them with a drug and live off a weekly office appointment like those other therapists".

I don't have a favorable opinion of psychiatrists. Can you tell?
 

Prof.Wizard

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Mercutio said:
So why bother with the therapy aspect? Psychiatrists - from personal enconuters - aren't given the quality of training in therapy that pyschologists are... the whole attitude is basically "let's fix them with a drug and live off a weekly office appointment like those other therapists".
Well, this is true. And that's why PxP should NOT be given to psychologists. They have different roles in the therapeutic approach. Psychiatrists are MDs well aware of the human physiology and pathology of mental diseases so they can grasp the whole pharmaceutical treating with ALL its collateral effects (and this latter is the difficult part for non-MDs). Of course the approaches of psychotherapy are being studied and practiced by them in much lesser extend, since there's a whole army of licenced Psychologists to work with them.

It's NOT true that Psychiatrists work like this: just throw the patient the anti-depressant and have a free weekend with the family-kids-dog. I don't know your personal experience but Psychiatry can deal with otherwise untreatable (for Psychologists) maladies I would need a couple of pages to sit and write if we wanted to discuss it thoroughly.
I don't have a favorable opinion of psychiatrists. Can you tell?
No. But most people still think the psy doc as the worst shrink. Psychiatrists are much needed for the well-being of our society. Trust me!
 

flagreen

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You wouldn't like here in Florida Prof. We have Osteopaths and Chiropractors who also write Rxs. Scary huh?
 

flagreen

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Tea said:
If they are so good at writing prescriptions, why can't they fill in a ballot paper properly then, eh? Tell me that.
Beats the hell out of me! We even have touch screen voting machines now. You couldn't make it any more simple. The election which is doubt now is a primary election to determine who the Democratic Party's nominee in the general election for governor will be. The counties who are having problem all have Democrats as their Supervisor of Elections. It's in their own best interest to do it right! Of course, the Democrats are now blaming the Governor who is a Republican! Unbelievable. Botswana here I come...
 

Mercutio

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Bill, I think we can find a replacement for Florida. Puerto Rico or maybe Guam would do just fine as the 50th state. The way Florida is going, maybe we'd be better off trading you guys to Cuba for a second-round draft pick and an island to be named later.

Yes, Prof, I had some really lousy experiences with Psychiatrists. Really, really lousy. They think they're therapists and they aren't.

I'd rather have someone who really is a therapist look at my mental state to decide whether to put someone on medication than to prescribe meds first, and then work out the therapy later (that seems to be SOP for a psychiatrist here). When there's a snap "He's depressed, get him some prozac" mentality among the MD-types (just like there's a "You might be sick, better get you some antibiotics" mentality among GPs), why not let someone besides the MD-types pass out the psychoactives. You see one, you're going to get them anyway, probably even if you don't need them.

My personal feeling is that, if non-MD mental-health workers were required to fulfill some additional training to get Px rights, they might be LESS likely to abuse them, since, unlike the psychiatrist, 'scrip writing for them wasn't just a perk of the profession.
 

Prof.Wizard

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Mercutio said:
My personal feeling is that, if non-MD mental-health workers were required to fulfill some additional training to get Px rights, they might be LESS likely to abuse them, since, unlike the psychiatrist, 'scrip writing for them wasn't just a perk of the profession.
But Mercutio, the Psychiatrist is just another figure of the healthcare system. I don't know how you ended up getting advice directly by him, but trust me, the natural (orthodox) way of reaching him is after having exhausted all the "first" waves:
Consulted your GP/FP... who would suggest seeing a Psychologist... who will suggest organic failure and suggest you a Psychiatrist... who on his turn will do a thorough examination (MD-style) and prescribe medication...*

As far as I'm concerned, although I voted the 2nd, Psychologists might prescribe placebos ("sugar pills")... most people WILL respond since most are "thinking" they're sick... they are NOT!


*there's a further step if you're interested... I'll deal with it sometime in the future, hehe... it's called Psychosurgery... it's for those maladies even Psychiatrists can NOT deal... medical refractory psychological diseases...

OK OK, joking... :roll:
 

SteveC

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flagreen said:
Tea said:
If they are so good at writing prescriptions, why can't they fill in a ballot paper properly then, eh? Tell me that.
Beats the hell out of me! We even have touch screen voting machines now. You couldn't make it any more simple. The election which is doubt now is a primary election to determine who the Democratic Party's nominee in the general election for governor will be. The counties who are having problem all have Democrats as their Supervisor of Elections. It's in their own best interest to do it right! Of course, the Democrats are now blaming the Governor who is a Republican! Unbelievable. Botswana here I come...

Janet Reno wants a full manual recount of the entire state. Here we go again.
http://abcnews.go.com/sections/politics/DailyNews/wnt_fla_020912.html
http://www.foxnews.com/story/0,2933,62988,00.html

Mercutio said:
Bill, I think we can find a replacement for Florida. Puerto Rico or maybe Guam would do just fine as the 50th state. The way Florida is going, maybe we'd be better off trading you guys to Cuba for a second-round draft pick and an island to be named later.
I'll gladly take Puerto Rico for statehood, although in the last election for statehood, "None of the above" got the most votes. Considering some of the candidates we have, that may actually be the best choice for other elections.

Steve
 

Ekaf-Ami

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Who is this Mr None Above? Is good man? What party he belong to? No matter. When get Green Card, I vote for him anyway.

(Pity he not be standing in my country. No-one stand for election in my country, in case he get shorter all-sudden. Head of Government one question. Head on shoulders still, that be different question.)
 

SteveC

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Ekaf-Ami said:
Who is this Mr None Above? Is good man? What party he belong to? No matter. When get Green Card, I vote for him anyway.

(Pity he not be standing in my country. No-one stand for election in my country, in case he get shorter all-sudden. Head of Government one question. Head on shoulders still, that be different question.)
Mr. None Above is very good man. He never makes promises he doesn't keep, and never takes campaign donations. Write in vote for Mr. None Above.

Seriously, the last election for statehood was non-binding, and the vote was more a referendum against the Governor than anything else. The choices were:
1. remain a U.S. Commonwealth
2. enter a "free association" with the U.S.
3. become a state
4. declare independence
5. None of the above
"None of the above" got 50% and "become a state" got 46%. Independence got about 2%. Normally, becoming a state and remaining a commonwealth are about evenly split, with independence getting about 2-4%.

Steve
 

flagreen

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I have visited Puerto Rico many times on business. It is a beautiful island. I would not mind living there at all except for one little problem - I don't speak Spanish. Well not much anyway. I can order a cup of coffee or a beer and I know how to say "I'm sorry I don't know how to speak Spanish" but that's about all. Come to think of it, that's just about all a man needs to know anyway isn't it?
 

SteveC

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flagreen said:
I have visited Puerto Rico many times on business. It is a beautiful island. I would not mind living there at all except for one little problem - I don't speak Spanish. Well not much anyway. I can order a cup of coffee or a beer and I know how to say "I'm sorry I don't know how to speak Spanish" but that's about all. Come to think of it, that's just about all a man needs to know anyway isn't it?

Don't worry, I don't speak Spanish either and I am Puerto Rican (well, I do speak it, but with a horrible accent. I can't roll my r's, but I can understand it enough to get by). I love Old San Juan and I want to retire there, but that's a long way off.

Back on topic (sorry, Prof.!). I voted "no" because I think we are already over-medicated as a society. I think people often look for the quick fix with a pill when it may not be the right solution for them.

Steve
 

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SteveC said:
Don't worry, I don't speak Spanish either and I am Puerto Rican (well, I do speak it, but with a horrible accent. I can't roll my r's, but I can understand it enough to get by). I love Old San Juan and I want to retire there, but that's a long way off.

Has PR adopted the US constitution? If so, how is it different from Virginia, another commonwealth. PR women. Gotta love em.

PS. I'm with Steve on the Rx.
 

SteveC

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Cliptin said:
Has PR adopted the US constitution? If so, how is it different from Virginia, another commonwealth.
No, PR has its own Consitution which, of course, is largely based on the U.S. Constitution. If you're interested, you can read the full text of it here. All Puerto Ricans are U.S. citizens and they elect 1 U.S. Representative, but he(she) doesn't get a vote in Congress. Also, there's no electoral vote for President, and there are no federal income taxes.

Cliptin said:
PR women. Gotta love em.
Absolutely!!

Steve
 

Prof.Wizard

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SteveC said:
I voted "no" because I think we are already over-medicated as a society. I think people often look for the quick fix with a pill when it may not be the right solution for them.
I think this poll so far was a success because it made us all think... :)
Just yesterday that I checked it was 25% all four answers!

I think our society is over-medicated as well. That's the point: most people think they are sick... they're not! They're just too lazy to get up after misfortunes... Anyway, it's good the "NOs" prevail so far. Good for the science of Psychology per se and the patients to be treated as well...
 

jtr1962

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Here's another no vote, and the reason is because, frankly, we're too much in a hurry to pop pills for everything without going after the underlying problem. For example, a person may come in who is legimately depressed(as I was for about 6 months after the WTC attacks). Instead of the psychologist trying to help you sort out the issues that may be making you depressed, they'll just prescribe a pill. In my particular case, I simply let time run it's course, and knew that as the event receded further in the background, I would feel better. I obviously wasn't in a position to do anything about it, and I don't really see what the point of seeing a psycologist/psychiatrist would have been, anyway. You should feel profoundly depressed at certain times in your life. It is healthy and normal. What is not is our society's obsession that we should always be happy and unaffected by everything going on around us. There is an old saying about the wrong people being locked up in mental institutions that I often feel is true.

Another reason for my feelings in that I think in time the overuse of Ritalin on our children will be seen as one of the crimes of the late 20th/early 21st century. Many times this drug is prescribed simply for the convenience of teachers/caretakers unable to cope with normal children whom they think should act like miniature adults. Instead of making a greater effort to keep the children interested/occupied, they recommend prescribing a drug that zombifies them. I dread to think what the long term effects on the body will be from these drugs, especially the kidneys. I think we may be condemning our children to a lifetime of ill health just for the convenience of a few lazy adults who are ill-equipped to deal with the children placed in their care, and should really find another line of work.

I remember the first and only time a saw a psychitrist was in third grade. The teacher for some reason felt something was wrong since I didn't socialize much(how much socializing does anyone really do in third grade, anyway?). Thankfully, the psychiatrist pinpointed the "problem" right away, after a few tests and talking with me. It turned out(although I wasn't able to verbalize it at the time) that I was so far ahead of all my classmates that I simply found them boring to be with, and preferred adults. A more competent teacher would have realized this, but the psychiatrist hit the nail on the head when he said that I was probably smarter than most of my teachers. Eventually, in the later grades I did start socializing as my peers "grew up", and since I went to one of NYC's specialized high schools, I found plenty of students just like me, and had no problem making friends. I really never had a problem, and thankfully didn't suffer any lasting effects from that teacher's stigmatizing of me. BTW, this is the same teacher who occasionally used to cry in the hallway when she couldn't cope with her class. Makes me wonder who really needed the help now.
 
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