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Psychologists: Trained to recognize medical problems

Vol. 5, No. 2 / February 2006
This week's quiz:
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In her letter “ Why MDs — not psychologists — prescribe ” ( Current Psychiatry , January 2006), Dr. Susan Redge provides a brief case report to illustrate why she feels psychologists are not qualified to prescribe psychotropics.

I appreciate Dr. Redge ’ s attempt to facilitate discussion of an issue that affects both psychology and psychiatry, but I ’ m not sure that her case is a valid and representative example.

First, clinical psychologists receive on average 7 years of graduate-level training in assessing and correcting psychological and psychiatric disorders. Thus, the clinical psychologist is more than qualified to recognize the incongruence between the sample patient ’ s clinical presentation and history.

Second, the patient “ spontaneously ” disclosed that he has type I diabetes mellitus. This was not discovered through an in-depth clinical interview or laboratory analysis, so I cannot see how having a degree in medicine versus psychology applies in this example.

Finally, upon realizing that the patient ’ s blood glucose was abnormally low, Dr. Redge referred the patient to a higher level of care. Any competent clinical psychologist would do the same.

I encourage Dr. Redge to consider the extensive training clinical psychologists receive in diagnostics, assessment, and intervention. I also suggest that she review programs that provide psychopharmacology training for psychologists. She — and other psychiatrists — may be surprised.

Bret Moore, PsyD
Houston, TX

Dr. Redge responds

I did not intend to suggest that psychologists are not well-trained or extensively educated. And I did not know, as Dr. Moore suggests, that their training is equivalent to medical school.

I tried to make my letter brief and to the point, which is probably why Dr. Moore assumed that my patient “ spontaneously ” disclosed that he had type I diabetes. I asked the patient numerous questions, some of them admittedly leading. Still, eliciting the information was not easy. I did have a high index of suspicion, however, which was why I ordered a blood glucose check. I analyzed the results and identified hypoglycemia, which was why I ordered the nurse to give him some orange juice and get him to the ER.

I doubt that an “ in depth ” clinical interview would have comforted the patient ’ s family if he had slipped into a coma and died. Time can be critical.

To me, this patient dramatically showed how an organic illness may present as psychosis. It was a defining moment in my life; I felt gratified that my years of education and training allowed me to help someone, and that I had to be a physician first.

Insurance companies, and even some other physicians, do not fully appreciate the psychiatrist ’ s role in medical care. Consequently, some insurers try to save money by letting nonclinicians offer psychiatric care. They must remember that psychiatry is a medical specialty and all psychiatric illness is medical illness.

Susan Redge, MD
Rochester Hills, MI

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