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Friday, January 15, 2010

Differences Between Psychiatrists, Psychologists and Psychotherapists


I am not a psychotherapist. I am a psychiatrist. Psychotherapists are non-physician mental health providers. They include psychologists, licensed clinical social workers, and marriage and family therapists. Because they are not physicians, they cannot prescribe medications. Let me emphasize, psychologists are not physicians. Most of my patients don't seem to know the difference. As a physician, I am able to diagnose any medical illnesses that present as mental symptoms. For example, a patient with weight gain, decreased energy and loss of interest in her favorite activities is consistent with a diagnosis of Major Depression. This patient I recently saw complained that these symptoms had slowly progressed over the last 2 years and had not gotten better with several months of weekly psychotherapy. There was no previous medical history. I ordered labs (which a psychologist cannot do) and found low thyroid hormone, a condition called hypothyroidism. I then referred her to an internist friend of mine. Later, follow up with her revealed no symptoms of depression, her energy and mood had improved, and she had lost weight with thyroid replacement. I discharged her from my practice, cured.

I am a medical doctor who specializes in the treatment of mental diseases, just like a cardiologist specializes in the treatment of heart diseases. Psychiatry treatment includes diagnosis, medications if necessary and psychotherapy. I perform medical testing if indicated and admit patients to hospitals like other medical doctors. I can also submit to courts petitions for involuntary treatment. Non-physician psychotherapists and psychologists can only do psychotherapy and not the other functions of mental health assessment, like a physician who specializes in mental disorders can. Most of my patients are very surprised that most mental disorders can be diagnosed and treated very easily. Most of my patients are very surprised that mental health is health.

Dr. Phil is not a psychiatrist. Refer to Wikipedia for a good definition of what a psychiatrist is. Any non-physician psychotherapist discussing medications is practicing beyond the scope of their training. All psychiatrists are trained in all aspects of psychotherapy. In my office and I believe for most psychiatrists, psychotherapy is usually referred to non-physician mental health providers. It's just plain cheaper. The reality is most people and most insurance plans will not pay $300 or more per hour, per week for a psychiatrist. Honestly, I wouldn't pay that either. I also believe good psychotherapy can be done with other psychotherapists. I usually relegate myself to making a diagnosis, establishing a treatment plan and referring patients to psychotherapists for goal oriented treatments. These plans are aimed at restoring health and function in the easiest, quickest way possible. This biopsychosocial approach is beyond what non-physician mental health providers can do. Once a treatment plan is started, I make sure all the goals of the treatment plan are achieved to restore health and normal function.

I hope this narrative provides clarification. Next I'll be posting on how psychiatry treats mental diseases.

Saturday, January 2, 2010

Unhinged vs Unplugged

The week before Christmas, I saw 75 patients in my office. 10-15 were new patients and the majority of these patients had know idea about what I do. In the end, I'm glad they had the nerve to come. I don't think I'd go to a doctor's office without having some idea of what to expect.

Most were relieved to find out they suffered from simple mental diseases that are highly treatable. However, the misinformation that most of my new patients relayed to me was down right crazy. In my practice I don't see crazy very often--seriously.

Most people thought I do "Soprano" psychiatry where I'm sitting in a plush office with a patient asking deep
probing questions about their childhood for 1 hour. Others thought I do "Tom Cruise" psychiatry and give out pills in some haphazard fashion on request. The fact is most psychiatrists don't do either.

This blog I'm hoping will dispel these myths and bring some common sense and straight forward explanations about what psychiatry is and is not, what it does and doesn't do, what it can and can't do. Mental diseases and all aspects of treatment will be discussed, clarified and simplified. Current information and standards of psychiatric treatment and disease management will be emphasized. In short, I'll try to put some sanity into defining psychiatry as my medical specialty.

Prior to Christmas I did feel unhinged. Now I feel better. Psychiatry unplugged is how I'm starting the New Year!