From: dyer@spdcc.com (Steve Dyer)
Newsgroups: sci.med
Subject: Re: [Prescription Privileges]
Date: 11 Sep 92 02:27:47 GMT
Article-I.D.: spdcc.1992Sep11.022747.25001
Distribution: na
Organization: S.P. Dyer Computer Consulting, Cambridge MA

In article <88516@netnews.upenn.edu> zorrilla@cattell.psych.upenn.edu (Eric Zorrilla) writes:
>What do mental health professionals out there see as the future of
>prescription privileges vis a vis clinical psychologists?

I'd love to hear what Mark Kline and other psychiatrists and the other
MDs have to say.  As a non-mental-health non-professional, I'd just want
to first ask a question: to what extent is this necessary?  What problem
does this solve?  Surely a psychologist's time isn't less expensive than
a psychiatrist's.  :-)  I'm not being sarcastic.  Is there a problem with
access to psychiatrists right now?

>	1)  Should an appropriately trained psychologist be granted
>	limited prescription privileges of psychoactive medications?

One key issue which seems to arise here is the relationship of
the two professions, namely clinical psychology and medicine.
Prescribing privileges have been traditionally granted to
practitioners of medicine and the related professions, dentistry
and podiatry.  Other fields (physician's assistant, nurse midwife,
nurse practitioner, and somewhat analogously, nurse anesthetist)
have been granted these privileges in some states, but in a subsidiary
relationship to a supervising physician.  Though I suppose there might
be considerable autonomy in practice, I believe that they're really
acting as an agent of the physician.

Now, having said this, and pardon the image, but I'm not so sure that
clinical psychologists would be too eager to jump into bed to act
as the passive partner in this marriage of convenience with psychiatry.
Am I right?  That is, one proposal would undoubtedly be to give such
trained psychologists considerable autonomy in the ability to prescribe
psychotropic drugs, not necessarily in partnership with a physician.
This would undoubtedly raise some concerns in some medical circles.
Some of this could be described as a turf issue, which has both self-
serving and patient-serving components, but which are nonetheless valid
considerations.

First, despite what is claimed semi-seriously by some MDs,
psychiatrists are first and foremost medical doctors, and supposedly
treat their patients with this in mind.  What does it mean for a
psychologist to have the ability to prescribe drugs?  What does this
say about the care of the patient, and also about the role of the
practitioner?  The other argument is that blah, blah, only doctors
truly understand what it means to prescribe drugs, and that patients
will not be well served by giving prescribing privileges to someone who
does not have a primary medical background.  The question is, will
patients be better off in the end, and also, what kind of education
would be necessary?  At this point, I'd imagine that you'd want a
background in physiology, pharmacology and medicine at least at the
level of a nurse practitioner.  I don't have the faintest idea of how
this overlaps, if at all, with the education of a clinical psychologist
right now.

-- 
Steve Dyer
dyer@ursa-major.spdcc.com aka {ima,harvard,rayssd,linus,m2c}!spdcc!dyer
Newsgroups: sci.med