Wednesday, December 17, 2008

Psychologists as Prescribers

The debate rages on here. Well, perhaps not rages but is, at least, current.

Should psychologists prescribe medication? I have to say that I'm not keen on this move forward.


Even with the provision of more in-depth psychopharmacological training, I don't believe the level of knowledge would be sufficient to account for all the variables that need to be considered in medicating someone. From a personal point of view, I think a medical background is essential.

I also think that many patients prefer their psychologists as non-prescribers, especially those that don't want to go down the medication route. I'm not adverse to medication at all and patients who are intially resistant to the idea will often reconsider as an interim measure if they're having trouble doing psychological work. When that happens, both the patient and I seem comfortable having either the patient's doctor or a psychiatrist involved.

What do you think? Drop a comment or tick off a box on the poll in the side bar.


Anonymous said...

I have mixed feelings on the RxP debate. I think that it's a good idea in that patients can receive complete services from one person and that the psychologist has more knowledge of what meds do and how they work. On the other hand, it's something that the medical community doesn't want to share. As a result, it's expensive and time-consuming in those places where a psychologist can actually be credentialed to prescribe (only a few states allow it in the US so far). And like you said, the medical background for a psychologist isn't as complete as the one a psychiatrist has. Psych meds are enough of a crapshoot as it is.

If it were me, I would do the training so that I would have a better understanding of the meds, but probably wouldn't end up prescribing. There's also the thing that liability and insurance rates would probably increase for those that prescribe. That wouldn't be fun.


Clueless said...

My answer is absolutely I do not believe that psychologists should be allowed to prescribe medications. The training and approach is completely different. I am a patient and I work in the mental health field.

Psychiatrists are needed for their medical background, interactions with other medications, history of what works, and keeping updated by the constant changes in medications. Along with the necessary documentation and dealings with insurance companies.

They approach via a medical perspective. I do think that some psychiatrist, mostly the older ones, are able to also provide psychotherapy. But it doesn't work the other way around.

Finding a good psychiatrist is hard enough and it is such a stab in the dark to find the best combination of medications for someone. I would want someone with a medical background and a some psychotherapy training.

This is a really scary thought!

phd in yogurtry said...

Personally, I don't want to have to deal with the medication side of the profession. I am very relieved to say "discuss that with your M.D." As it is, I spend what I believe to be too much time listening to side effects complaints.

Psychgrad said...

I think it would be a slippery slope leading to a focus on medication rather than talk therapy. Plus, I already think clinical programs are long and stressful enough. I wouldn't want to add another couple of years on to them, nor would I want to sacrifice the training for the sake of shoving in more of a medical component. As well, if I were being prescribed medicine, I would want it to come from someone with a vast knowledge about how the body functions and any side effects or drug interactions that accompany different drugs.

Dreaming again said...

As a psych student, that scares the fire out of me. Um ..if I wanted to rx meds, I'd go the psychiatry route!

Get the MD or DO .. do the medicine, learn the body and anatomy and all the ins and outs that meds can effect ...

Awake In Rochester said...

Here in the U.S. I believe that psychologists do prescribe meds. I don't know if it's right, or wrong. I don't know how much education and training in meds that psychologists have here. If they are really qualified or not.

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Dr. Deb said...

I, personally, don't want to be a prescriber. I like mastering the talking therapy piece to treatment.

tracy said...

Awake No, i'm pretty certian they don't.

SeaSpray said...

The psychologist I saw didn't but I stopped therapy in could have changed, but I thought it has to me an MD.

Anyway... I would feel better knowing the prescription came from an MD. I would assume they would consult first.

Physicians have a lot more background with the human body.

The ideal would be the patient's pCP who would have access to health records/know the patient.

Then again, the psychiatrist works with the mind and has the medical background.

The ideal is to have the WHOLE picture of the pt before prescribing...says this lay person.

Alison said...

I love it when I say, "I'm not a doctor". I'm happy to have these fields remain separate.

Tigermom said...

As a psychiatrist studying for my boards re-certification exam, I can only say Why would you want to get prescribing rights? There is so much information to really understand -not just know.

This is not about having a stash of facts in your head, it is about knowing how the body works, how the medications work, what the medications interact with one another and the persons unique body situations, with the person's other medical issues, and the intensity of the training experience ie seeing the bad outcomes over and over again so that you can spot a zebra in a crowd of horses.

Yes having one person able to understand the psychology and the medications is great! You can have that in a good psychiatrist. You can also have that in a true collaborative relationship with a psychologist (or other non MD therapist) and a psychiatrist.

Back to the books!

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Health Information Resource said...

I believe that psychologists should be given special training about the medications by the doctor fraternity. A examination should be taken and then the psychologists should be given the permission to prescribe medications. I think this can be the solution.