Friday, June 23, 2006

I agree with Shiny Happy Person and some other random thoughts




Shiny Happy Person of Trick-cycling for Beginners (will I ever understand that blog name?) writes about her frustration with Nurse Practitioners prescribing in Bonkers New World. Her post has 30 comments and going, so a topic with some heat to it. I'll take it a few degrees higher and say I think patients get the best care when they see a psychiatrist for both their psychotherapy and their medications. Just my opinion.

Roy, I just listened to your animated cartoon link re: NSA wiretapping. I can't decide how I feel about it. How was I supposed to feel?

Manny is having a good night, the Red Sox are winning 7-2 against the Phillies.

15 comments:

Anonymous said...

my mom wrote this and shes a geek, shes sitting here with her pants pulled up to her ribs, with a rasberry stained target tee shirt thats too short. since shes started this blog shes become a wanabe computer geek, she talks about her posts at dinner everynight and tells us about her codes for hyperlinking, thinking it has meaning to us, she gives all of her friends the url excepecting to read it, most of them(all of them) really dont care about psycaitry

ClinkShrink said...

Hmm...I'm beginning to understand why some animals devour their young...

Cheryl Fuller, Ph.D. said...

I've been a psychotherapist for 34 years now. I am a psychologist, not a psychiatrist. I think the push on the part of some clinical psychologists to get prescribing credentials is frankly ridiculous. And I also think it is more about turf issues than it is any of the noble sounding arguments about patient care which are used to support this notion.

When I am seeing someone who may need psychiatric meds, I always refer to a psychiatrist. I am far more concerned about GPs and internists who prescribe psychotropic drugs than I am a about nurses, mostly because there are far more of the former doing than there are clinical nurse specialists.

And sorry to end this on a sour note, but most of the young psychiatrists I know are too poorly trained in psychotherapy for me to believe they are the best choice for therapy. In fact I provide clinical supervision for several of them and am surprised at how little they do know about doing therapy.

So on meds, yes, I agree. On therapy -- nope. Experience and additional training, including having had personal therapy, is more important than the degree.

On the Same Page said...

I found out that one friend, a PGY2, and another friend, an MSW intern, without knowing one another (making them I-don't-know-what-degree-of-separation from Mr. Bacon) were assigned to conduct a therapy group together at the University out-patient clinic. Speaking with them independently was hilarious. He, the PGY2, had read a bit about group therapy and had been to a "seminar,"; she, the MSW intern, had worked in a group home and had co-facilitated some groups. He said, "I didn't know what to do, and she seemed to have an idea." She said, "I was so frightened because he was the doctor." Who only knows what the patients thought.

"Pants pulled up to her ribs?" So much for positive transference, Dinah. And for heaven's sake, get the kid a spell checker...

Spiritual Emergency said...
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NeoNurseChic said...
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Spiritual Emergency said...
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NeoNurseChic said...
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Shiny Happy Person said...

Dinah - thanks for the link (you do know that isn't really a picture of me, I hope....?)

Won't enter into the discussion here (had quite enough of it on my own blog), but thought I'd explain the blog name. Funny, I always thought it was quite obvious. Only to me, it seems....

Anyway. "Trick-cyclist" is a reasonably common nickname for "psychiatrist". Maybe it's more of a British thing, but I'm sure it's not exclusive. I am a relative beginner in psychiatry. Et voila. It all becomes clear. I hope.

I also kinda liked the overlap with cycling as in rapid-cycling, mood cycling, cyclothymia, yada yada yada. Sometimes the ability to maintain the balance on your cycle feels like you need to be some sort of stunt cyclist. And I'll always feel like a beginner cos I'm not sure I'll ever really get the hang of it. Today I will be mainly doing wheelies and then falling off and hurting my ass.

Ye gods. Welcome to my brain.

Dinah said...

That's NOT you???? Oh, my.

I've never heard the Trick-cyclist reference. Here in the USA, we go for Head Shrinker and the like.

Shiny Happy Person said...

No. If only I were that attractive.

Roy said...

I thought SHP came from the REM song, ""Shiny Happy People".

I'm with Dinah... never heard the trick-cycling reference... but I had figured on the reference to mood cycling, and even to falling down (new doc and all).

Other thoughts:
-Carrie wondered why her doc never put her on an antidepressant. "God knows most days I wonder why not. LOL " ... it's because of the LOL. If you couldn't LOL then maybe he would. Of course, if you were ROFLYAO, then he'd probably reach for the lithium.
-Good points on therapist-pt relationship... I agree that this is what makes an effective treatment... at least, it is a necessary, but not sufficient, ingredient. Skill, experience, education, sensitivity, and humor, are all necessary, as well.
-University of Maryland has a Psych NP program. I think it is a good option to have such trained individuals. We have one in the community whom all the pts refer to as "doctor". It bothers me that he does not correct this misconception in a stronger manner... which brings up an idea for a blog (see blog on proposed legislation about confusing other health professionals with physicians).
-Dinah, I hope the raspberry stain came out.

NeoNurseChic said...
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Shiny Happy Person said...

Roy - yes, SHP does come from that song. REM are my favourite band in the world ever, and I also enjoyed the irony of the name; I'm always such a miserable bastard! But then there are times when I'm very shiny and very happy and....well, you know the rest.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2049009&dopt=Abstract

http://www.urbandictionary.com/define.php?term=Trick+Cyclist

http://www.trickcyclists.co.uk/

http://www.allwords.com/word-trick%20cyclist.html

http://www.britannia.com/travel/london/cockney/slang.html

Just in case you're interested...

Nutty said...

I've seen a variety of therapists, counsellors, psychotherapists etc. Some were doctors, some were nurses, some were not qualified at all.

I have formed the view that it is horses for courses. If all you want is some basic (and I stress basic) CBT or a little counselling, then the qualifications of the person offering it aren't terribly important.

If you want something deep and long term, then you want someone with the training and experience to offer that, but personality and gender also matter, perhaps as much as the qualifications.

Sadly, the two doctors I saw for psychotherapy were the least helpful. One was a consultant psychiatrist and more interested in office politics than my healthcare.

So my view is that it is not just psychiatrists that can offer good talking therapies, and that sadly in some instances they are not a very good option at all.