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Posted-Date: Tue, 1 Sep 92 22:18:47 EDT
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Date:         Tue, 1 Sep 1992 22:18:47 EDT
              <PSYCGRAD@UOTTAWA.BITNET>
From:         Eric Zorrilla <zorrilla@CATTELL.PSYCH.UPENN.EDU>
Subject:      Re: Psych-iatry vs -ology?
X-To:         PSYCGRAD%UOTTAWA.BitNet@pucc.princeton.edu
              92 1:25 pm

Nangel at UCLA writes (in RE to subject heading and what is appropriate
training)...

>      First, I think that it is precisely the clinical exposure which
> constitutes the bulk of the clinical training.  While the first two years of
> med school are mostly basic sciences (with the notable exceptions of anatomy
> and physiology), the last two years are usually "clinical exposure"

Of these two years of "clinical exposure" what proportion of cases are
psychiatric in nature?  The psychiatry rotation, certainly, but not much else.
(How relevant are most dermatology cases to drug regimens for Type II Bipolar?)
So, 6-9 weeks depending on the program (I think).  This type of clinical
exposure would almost certainly be provided in a clinical psychology student's
uncounted hours of practica.  Moreover, I'd be for some sort of post-doc
requirement where psych grads would be required to continue administering
medication under the supervision/direction of an experienced psychiatrist
or similarly qualified psychologist.  Such a final apprenticeship would
provide the final step towards eventual autonomy.

>      Second, when you are talking about the effect that drugs may have
> on different organic systems, or the interactions of multiple drugs on
> the human body (not to mention illness processes that may imitate,
> create, or exacerbate psychopathology) I don't think there are a lot of
> "time-wasting rotations" not relevant to your objectives.

I don't see how any of this is unique to the problem of prescribing medication.

A well-trained clinical psychologist should be as aware of these complicating
or mimicking conditions to perform the appropriate steps of referral.  Not
being so trained would result in errors of omission (in not providing ap-
propriate medical intervention).  I'm sure stuff like this happens all the time
as things go NOW and a corps of psychologists better trained in these medical
conditions would better prevent these mistakes (treating a depressive syndrome
caused by hypothyroidism with cognitive therapy, for example).

Second, I think you are greatly underestimating the current resources of
ready information which MD's currently have at their disposal (and so would
psychologists) to prevent misprescription of medication - particularly when
the class of medications that can be prescribed is so delimited.  The PDR
is EXTRAORDINARILY complete.  Surprisingly, drug companies also provide
pretty good information since they want to avoid lawsuits at all costs.  Your
average doctor knows little about the psychoactive medication he or she
is prescribing (w/out consulting the PDR) except for something like
"Imipramine is an old tricyclic w/bad anticholinergic side effects.  Let's
try something newer with less side effects like Zoloft."  Psychologists,
specializing in this subclass of medications, can certainly do much better.

>      On the other hand, I don't think recently graduated MDs should go around
> "giving therapy" in their first (or second, or third, but that's MY bias)
> year of internship/residency.

Agree completely.

Eric Zorrilla
University of Pennsylvania
Comments: Gated by NETNEWS@AUVM.AMERICAN.EDU