It has been an interesting last few days for this particular blogger. What began as a thought-piece about how psychologists prescribing might bring needed balance to psychiatric practice became a lightning rod for rage, mockery, and often interesting debate. No threats yet, though I did get the following anonymous note in the mail today: "Carlat you (expletive) turn coat. Stick this in your (expletive expletive)."
Civil discourse is alive and well in America.
But beyond that enlightening comment, there have been several good forums of debate. There are currently 86 comments to my March 22 post, and they represent a reasonable cross section of opinions on the issue. Many argued that psychologists would put patients at medical risk because a two year masters is not good enough. Some believed that psychologists would end up doing exactly what most psychiatrists are doing--short med check visits in order to make money. My friend Ron Pies tried to bail me out by referring to the post as "one of the most effective satirical sketches since Jonathan Swift's famous (or infamous) "Modest Proposal" but later posted a thoughtful rebuttal which he later developed into this interesting editorial for Psychiatric Times.
There's also a great forum on the Student Doctor Network. Entitled "Carlat and Overzealous Psychiatrists," there are now 78 comments. While every single person on that thread disagrees vehemently with me, I've enjoyed the back and forth because most of the writers are medical students or residents and seem to at least get a kick out of thinking this issue through.
Ultimately, I think the most valid potential argument against psychologists prescribing is the safety issue. Even though they have been prescribing since 1995, it is hard to figure out how to judge whether they are prescribing safely or not. As I understand it, there are 50 medical psychologists in Louisiana, 25 in New Mexico, and 20 to 30 in the various branches of the military. But nobody seems to know exactly how many patients they have seen or how many prescriptions have been written. Eveybody agrees that the number of prescriptions is in the "thousands," but is it 20,000? 200,000? 500,000? Size does matter here, because the larger the denominator, the more meaningful it is that there have been no complaints about prescribing psychologists to any medical board or any military authority.
I see my role, hopefully, as being an information broker between the psychologists and psychiatrists. I want to nail down some of the safety figures. I want to figure out what kind of safety surveillance would be adequate. There is so much animosity between the two organizations that it is nearly impossible to have a civil and rational conversation. I find that unfortunate, because the best psychiatric treatment is inegrative treatment, and the best way to achieve it is for the two professions to share information.
Whether psychologists end up continuing to snap up states in their quest to prescribe or not, I hope that we can all agree that patient care is our number one priority. Squabbling amongst ourselves over turf is not helping anybody.