Please don’t call call me a “prescriber”. Yes, I know it’s easier to say “prescriber” than “psychiatric nurse practitioner, physician assistant, or psychiatrist”.[1. I don’t know if ARNPs, PAs, and physicians are called “prescribers” in other areas of medicine. Do people call their cardiologists or pediatricians “prescribers”?] The word “prescriber”, however, puts severe limits on what I can do and how I can help.
You may believe that, because I have a license to prescribe medications, that’s all I choose to do. In fact, you may believe that’s all I know how to do.
Psychiatrists can do a lot more than that.
As a psychiatrist, I can:
- use interpersonal skills so that people feel comfortable talking to me about personal things
- help people design mini-experiments to determine if their beliefs about themselves are helpful or accurate
- prompt people to consider different sides of an issue to help them commit to decisions about their health
- encourage people to pause and reflect on their own thoughts, emotions, and behaviors
- teach people skills about how to manage the expectations they have of themselves and others
- educate people on how to help themselves so that they eventually won’t have to see me or another psychiatrist in the future[2. This list in technical terms would translate to:
- engage and build rapport with a wide variety of people
- gently challenge cognitive distortions
- enhance ambivalence, as in motivational interviewing
- encourage self-reflection to facilitate mindfulness and create more opportunities for positive reinforcement
- teach skills related to interpersonal effectiveness and the dialectic of acceptance and change
- help people exit the mental health system
While it is true that I might use those skills to encourage some people to take medications, I can also use those skills to:
- help people to reduce the number and amount of psychiatric medications they are taking[3. Some people end up taking multiple medications for unclear reasons. This often occurs when physicians do not have a clear diagnosis; they are instead chasing symptoms. One irritating example is the prescription of antipsychotic medications for insomnia… for someone who is not psychotic. Yes, antipsychotic medications are sedating. They can also cause high blood pressure, weight gain, diabetes, and involuntary movements. I’m not confident that all doctors regularly share this information with patients.]
- coach people to first try interventions other than medications[4. Remember, when we prescribe medications, we are recommending to people that they put chemicals into their bodies. In psychiatry, we often can’t offer solid explanations as to how these chemicals work. To be clear, I am not anti-medication; I use the word “chemicals” to highlight what we’re asking people to do when we write prescriptions.]
- provide education about the interactions between mind and body, whether related to medications or medical conditions
If my skill set is limited to prescribing medications alone, those automated psychiatrist machines will replace me in short order.
Psychiatrists should continue to strive to be the artisans of the clinical interview. As with the other specialties in medicine, the goals in psychiatry should focus on improving quality of life and reducing suffering. Sometimes that involves medications; sometimes it doesn’t.
The word “prescriber” overlooks those goals entirely.