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Commentary


Why MDs—not psychologists—prescribe

Vol. 5, No. 1 / January 2006

Granting prescribing privileges to psychologists, particularly in “underserved” areas, is a popular topic. Psychologists and social workers are integral treatment team players and in many cases know more about the patient than the psychiatrist does.

I recall, however, when I was a second-year resident in a crisis clinic. Police brought in a man who was floridly psychotic, out of control, talking nonsense, and behaving lewdly. He was a police officer who had just finished an extra shift. His fellow officers were concerned; they said he had never behaved like this, and they were reluctant to believe he had “gone crazy.” He was about age 30, an Army veteran, a decorated police officer, well-liked and dependable. After much effort, we got him into an interview room.

I was not afraid of him, but was a little irritated that he could not give me a coherent story. Then I asked him if he had any medical problems. Between the slurred words, nonsensical phrases and sexual suggestions, I heard “insulin-dependent diabetic.”

I requested a blood glucose check and got a reading of 39 mg/dL. I gave the patient some orange juice and told the officers to drive him across the parking lot to the ER. They were surprised; they had expected him to be admitted to the locked psychiatric unit, though they acknowledged that he had skipped his last meal and had given himself insulin.

The patient was admitted to the medicine floor, where he recovered quickly and was discharged. If not for the glucose check, we might have given him an antipsychotic and transferred him to inpatient psychiatry—and he could have died in the process.

A psychologist could very easily have missed this diagnosis. Psychologists who want prescribing privileges need to go to medical school first, regardless of how well trained and experienced they are.

Susan Redge, MD
Rochester Hills, MI

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