Blind Leading the Blind

I cringe every time I see this: A patient's counselor or psychotherapist, rather than referring him to a psychiatrist for whatever reason, instead recommends a drug they think has helped some of their clients, and the patient's physician prescribes it, often with no other justification than the fact that the (unqualified) psychotherapist recommended it. From a purely clinical perspective most psychiatric drugs cause little harm, even to those who should take a different drug -- or no drug at all. But in participating both professionals do the patient a disservice. Psychiatrists can make mistakes too, but we bring much more knowledge and experience to the table, and when those not adequately trained play psychiatrist they risk malpractice, and their license to practice.

Occasionally as well, the patient's record will come under scrutiny by a forensic psychiatrist, insurance reviewer or other third party, perhaps related to a claim, a problem at work, divorce, or a disability application. Indications for the drug, as well as adverse effects and therapeutic response can carry substantial implications in such cases, but the reviewing psychiatrist may be forced to discount what might otherwise have been useful in arriving at a determination, often to the detriment of the subject.

Many primary care physicians have sufficient experience to competently prescribe psychiatric drugs, but many non-psychiatric specialists do not. Inexperienced physicians will serve their patients -- and themselves -- better by declining to prescribe psychiatric drugs, and non-physician psychotherapists should let qualified prescribers decide which drugs to recommend to their patients.

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