From: mdkline@rodan.acs.syr.edu (Mark D. Kline)
Newsgroups: sci.med
Subject: Re: [Prescription Privileges]
Date: 12 Sep 92 20:05:32 GMT
Distribution: na
Organization: Syracuse University

In article <88583@netnews.upenn.edu> zorrilla@cattell.psych.upenn.edu (Eric Zorrilla) writes:
>In article <1992Sep11.022747.25001@spdcc.com> dyer@spdcc.com (Steve Dyer) writes:
>
>>...I'd just want to first ask a question: to what extent is this necessary? 
>> What problem does this solve?
>
>I could flip these questions and ask "To what extent is it necessary
>to bar appropriately trained psychologists from autonmous prescription pri-
>vileges? (Benefit of barring) What unique problems, if any, would be created
>by granting such a privilege? (Cost of not barring)"

Maybe there is no such thing as "appropriately trained" short of
medical school.  The "unique problems" of limited privileges include
problems for patients such as diagnosis  (is it depression or is it
hypothyroidism?  -- or is it cushing's syndrome?) and treatment (what 
about drug interactions, concomittant illness, etc).

>
>In regards to YOUR questions...
>
>	1)  First, if the cost of doing this is negligible, it is irrelevant
>*to the mental health field* to allow such privileges.

The cost is not neglible.  The costs include training, as well as
increased malpractice costs to psychologists. 

>
>	2)  Coherence of case management (some patients receive
>mixed signals about the value of psychotherapy from psychiatrists who are
>unfamiliar with which types of psychotherapy are efficacious - possible
>decrease in patient compliance) (also a proximate well-trained psychologist
>would probably be more effective than a consulted psychiatrist scribbling
>on a pad in drug management).

Some patients receive wrong signals about the value of medications from
psychologists who know nothing about drugs; does this mean that all
of us psychiatrists must therefore be trained to practice psychology?
Making psychologists into ill trained prescribers is a real nonsolution
to the coherence problem.  The solution is in better training and higher
standards for BOTH psychiatrists and psychologists.

>
>	3)  Autonomy of case management (It is unreasonable to believe that
>an appropriately trained psychotherapist should not be allowed to autonomusly
>provide complete patient care when a psychiatrist with a dash of psycho-
>therapeutic training is so authorized).

I'm not sure I follow this.  Trained and licenses psychotherapists ARE
autonomous in licensed private practice (as social workers, psychologists).

>	4)  Research psychologists (with appropriate backgrounds) currently
>have to look to MD's for studies involving any prescription drug.  Again,
>why not grant autonomy?

This is a nonissue.  Psychologists who are adequately qualified do
conduct basic psychopharm research; they do need MDs to collaborate 
with on the clinical side.  But again, why grant autoomy to a person
of lesser training (in pharmacology - i refer here to pharmcology
only - i don't regard psychologists as of lesser training generally).
The autonomy thing is sort of a red herring; nobody does a study
all by their lonesome anyway; clinical research is always done in
groups nowadays.  Most clinical psychopharm articles have psychologist
co-authors nowadays...

>Speaking from personal experience (as a current graduate student in a clini-
>cal psychology program), it varies tremendously in the field and this is why
>oversight would be crucial.  With some clinical psychologists, the educations
>certainly overlap (by the time I'm out of here, I'll have taken or done
>research in systems neuroscience, behavioral pharmacology, neuroendocrinology,
>psychoneuroimmunology, cellular immunology and as an undergraduate I had the
>typical pre-med curriculum (Orgo, Cell Bio, Intro to Physiology, etc.)  I sus-
>pect that this is relatively atypical so I don't think granting privileges
>would be equivalent to unleashing 100,000 "est"ers on the field.
>

Your psychology graduate program is unusual in terms of the training you're
getting; many programs are not as solid in the neurosciences.
But if you want to prescribe medications, and do it well,
my advice would be to apply to medical school.  Of course, if Senator
Inouye (? sp) and his psychologist staffer get their way, you may not
have to!

--
================================================================= 
mark kline                              mdkline@rodan.acs.syr.edu
suny health science center, syracuse    voice: (315) 422-1050
================ courtesy of syracuse university ================