Anyone heard of GP providing psychotherapy? (California)

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Anyone heard of GP providing psychotherapy? (California)

Postby elh919@aol.com on Tue Jul 21, 2009 10:24 am

Just curious to see if I am mssing something here. Patient in treatmet with Primary Care at industrial clinic for work stress and depression . Industrial clinic recommends referral to psych for consultation. Carrier provides patient a list of names to choose from in psych specialty. Psychiatrist sees patient and recommends medication management and brief psychotherapy.

UR comes back with no decision on med management, but denial for psychotherapy stating: "ACOEM and VHA/DOD state many patients with depressive disorder can be effectively treated in primary care setting. Referral is recommended for patient whose symptoms are not remitting. As the claimant has not failed treatment in the primary care setting and does not display red flag findings such as suicidal ideation, referral to psychotherapy is not medically justified." UR physician goes on to reference ACOEM Guideoines, Chapter 15, page 398 statting "...while common psychiatric conditions, such as mild depression, be referred to a specialist after symptoms continue for more than six to eight weeks" (patients complaints of depression go back to December 2008.) "The practioner should use his or her best professional judgment in determing the type off specialist. Issues regarding work stress and person job fit may be handled effectively with talk therapy through a psychologist or other mental health oprofessional.

My question is, has anyone ever heard of a General Practioner performing psychotherapy? The way I'm reading this is that psychotherapy can be performed in the primary care setting which usually is a General Practioner. I can understand a recommendation that psychotropic medication be prescribed in the Primary Care Setting, but psychotherapy?
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Re: Anyone heard of GP providing psychotherapy? (California)

Postby appliedpsych on Tue Jul 21, 2009 10:55 pm

I have never heard of a GP providing or even having inclination or desire to provide such treatment. In this case, they are just referring to a GP prescribing psych meds, which they can do, even though many times they get out of their depth. I think the IC just wants to delay and hope things change.

I heard an interesting statement in an M.D. heavy meeting recently - something like "yeah, we always have to jump in and provide quick treatment before they get better without it and figure out they don't need us" -- and they all laughed.

I guess the inside joke is that many times GP's are asked to treat all kinds of conditions that typically would resolve in a week or two if the person stayed home and never went to see a doctor.
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Re: Anyone heard of GP providing psychotherapy? (California) (Ca

Postby docwats on Fri Jul 24, 2009 10:50 am

Family physicians (and General Practitioners) are legally allowed to prescribe meds. I'm quite uncomfortable doing so - it gets us into a long-term situation with potential for serious liability when it comes time to discontinue. Psychotherapy usually means counseling sessions, and I would guess most Occupational and primary care docs wouldn't undertake this for the world.

I don't see the language quoted from Chapter 15 in my copy of the 2nd edition, perhaps it is from another.

In my practice, I won't prescribe medication to treat depression. There is a severe lack of psychiatrists who will take work comp. It is my position that, if the MPN does not have psychiatrists who actually treat patients under work comp (as opposed to being on the list) then the patient should be allowed to seek care from someone who will see him or her and the carrier pay what is asked by the practitioner.

There is also a great shortage of psychologists and other mental health providers who will provide care under WC, likely due to the poor reimbursement, heavy load of documentation and the contentious nature of many cases.

I usually advise patients they will be better off to keep their psych issues outside the comp system, regardless of how much merit their claim might have. It's often not much merit, but the system in CA generally assumes there is none.
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Re: Anyone heard of GP providing psychotherapy? (California)

Postby jonbrissman on Sat May 22, 2010 7:22 am

Not only all M.D.s are allowed to provide psychotherapy -- lawyers are, too! Business & Professions Code Sections 4999.20 and 4999.22 allow persons licensed in certain professions, including attorneys, to provide "counseling interventions and psychotherapeutic techniques to identify and remediate cognitive, mental, and emotional issues, including personal growth, adjustment to disability, crisis intervention, and psychosocial and environmental problems."

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Re: Anyone heard of GP providing psychotherapy? (California)

Postby rbaird on Sat May 22, 2010 3:14 pm

Of course, some of the attorneys who appeared before me would have been happy to provide some psychiatric intervention, but I was fine, just fine. Of course, I needed to get to the bottom of who stole the strawberries (Cf Caine Mutiny). Seriously, just because the legislature saw fit to enact an absurdity doesn't mean anyone should take it literally.
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Re: Anyone heard of GP providing psychotherapy? (California)

Postby jonbrissman on Sat May 22, 2010 4:07 pm

Judge Baird, let me assure you that I do not provide psychotherapy to the medical providers and interpreters that are my clients. But I think the Legislature envisioned that some lawyers deal with distraught clients who were recently bereaved, recently arrested, or amidst a contentious divorce (for examples). Such lawyers may counsel their clients about how to deal with misfortune and move on with their lives, and by the quoted statutes the attorneys cannot be charged with the unauthorized practice of psychology. Of course, an attorney may not hold himself out as a psychologist or advertise that he provides psychotherapeutical services. Nonetheless, a certain level of psychological counseling is involved in many areas of law practice. Most attorneys for injured workers, I would guess, would confirm this.

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Re: Anyone heard of GP providing psychotherapy? (California)

Postby rbaird on Sun May 23, 2010 5:15 pm

I stand corrected. Of course, I dealt with upset and grieving clients and provided some comfort but I did not and do not regard this as "therapy". I have never heard of an attorney disciplined for providing some incidental counseling.
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Re: Anyone heard of GP providing psychotherapy? (California)

Postby jpod on Mon May 24, 2010 8:35 am

Jon, Jon, you are falling for that liberal minded touchy feely stuff again....the legislature was concerned about how clients were reacting to the bills from their attorneys; it was becoming an epidemic, clients dropping like flies at the sight of the bill, something had to be done!!!!!!

just joking.....
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