From: zorrilla@cattell.psych.upenn.edu (Eric Zorrilla)
Newsgroups: sci.med
Subject: Re: [Prescription Privileges]
Date: 11 Sep 92 03:47:48 GMT
Distribution: na
Organization: University of Pennsylvania

In article <1992Sep11.022747.25001@spdcc.com> dyer@spdcc.com (Steve Dyer) writes:

>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?

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)"

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.

	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).

	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).

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

>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.

Agreed.  Probably because, traditionally, they were the only ones who were
appropriately trained to dole out the drugs.

>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.

Isn't that, in effect, what the current consultative marriage is?  I think
many of us want a divorce.

>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.

As do/did admissions privileges, but the courts appear to be making the
right decision there.  Pharmacotherapy, admittedly, is a different Pandora's
box altogether as there is a legitimate question of preparedness.

>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.

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.

[--------------------------------------+--------------------------------------]
| Eric Zorrilla - Dept. of Psychology  | zorrilla@cattell.psych.upenn.edu     |
| University of Pennsylvania           | 3815 Walnut, Philadelphia, PA 19104  |
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Newsgroups: sci.med