[Magdalen] Drug research.

[James Oppenheimer-Crawford]

The comment to which I responded was

"no doctor should be allowed to prescribe such
medications who has not taken an intensive course in psychopharmacology,
passed an exam with a sufficiently high score and been certified."

and to my knowledge, the only credential that addresses that is board
certification in psychiatry.

It's a great standard to have, but most folks with that certification don't
end up in state facilities for very long. I recall one who was with us for
a while, and ended up disappearing after about two months. We could not
afford them.

I've always said that the nurses are the medical staff who actually keep
the consumer alive. However, the topic (see above) was prescribing of
medication.

Most of the standards for that simply cannot be rule-driven. We worked on a
team concept for many years, and we were committed to that standard.  Did
it work? Sometimes it worked very well.  Some teams did superb work, while
others, with folks no less qualified, foundered.  Ideally the best
treatment came out of treat team meetings, when even the choice of
medication was a result of team interaction.

One physician would make notes during the meeting and write
prescriptions accordingly.  Another would just go back to her office and
write what she decided was best.  At the end of the day, if the medical
director thought the physician was doing good work, that was it. You can't
legislate this sort of thing. NYS tried to -- and nobody liked it.

James W. Oppenheimer-Crawford
*“A life is like a garden. Perfect moments can be had, but not preserved,
except in memory. LLAP**”  -- *Leonard Nimoy

On Sun, Aug 28, 2016 at 9:23 PM, Jay Weigel <jay.weigel at gmail.com> wrote:

> I was, for much of my career, ACLS certified, and for ALL of it, CPR
> certified. Those aren't board certifications. One can receive certification
> in a number of things that are NOT board certifications in nursing, also
> (per my brother the MD) in medicine, and in other disciplines.
>
> On Sunday, August 28, 2016, James Oppenheimer-Crawford <
> oppenheimerjw at gmail.com> wrote:
>
> > Sorry, but if you don't mean board certified, then what would you mean?
> > I've worked with a lot of physicians who were not psychiatrists, yet
> made a
> > serious effort to know their stuff, and I think they did a pretty good
> job
> > overall.  We did get a few clinkers, of course, but that's par for the
> > course.
> >
> > Sorry you were offended, since I agree with you.
> >
> > James W. Oppenheimer-Crawford
> > *“A life is like a garden. Perfect moments can be had, but not preserved,
> > except in memory. LLAP**”  -- *Leonard Nimoy
> >
> > On Sun, Aug 28, 2016 at 9:07 PM, Jay Weigel <jay.weigel at gmail.com
> > <javascript:;>> wrote:
> >
> > > I did not say "board cerified psychiatrists". I said them *and* other
> > > doctors who had taken a course in psychopharmacology, passed an exam,
> and
> > > gooten a certification. Please do not misquote me.
> > >
> > > On Sunday, August 28, 2016, James Oppenheimer-Crawford <
> > > oppenheimerjw at gmail.com <javascript:;>> wrote:
> > >
> > > > It's a dicey business.  On the one hand, you're absolutely right:
> only
> > > > board certified psychiatrists ought to be able to prescribe.  On the
> > > other
> > > > hand I can think of two serious considerations here:
> > > > First of all, many psychiatric facilities run by the states have a
> > > history
> > > > of employing MDs who are not board certified. It's not too extreme to
> > say
> > > > that if only board certified MDs could prescribe, we would not be
> able
> > to
> > > > hire the people at the price they are willing to pay. They simply
> > > wouldn't
> > > > be able to get the personnel.
> > > > And the other matter is the rapidly changing pharmacological picture.
> > I
> > > > recall when I first began to work back in 1975, there were not a lot
> of
> > > > meds available. But that quickly changed.  I had kept current on
> > > > medications' main purposes, side effects, general dose range, etc.,
> but
> > > in
> > > > just a few years it became a hopeless case.  Every year brought some
> > new
> > > > validated medication and new protocols. And also, the sudden terror
> of
> > > > retinitis pigmentosa from Mellaril and the general concern about
> > tardive
> > > > dyskinesia suddenly changed utterly the way medication was
> prescribed.
> > > > Also, we would welcome a new antipsychotic with the hope that this
> one
> > > > might be that magic bullet. And it almost never happened that way.  I
> > say
> > > > this to illustrate how a physician completely up to date and
> certified
> > > in,
> > > > say 1990, might quite easily be completely out of touch in just a few
> > > years
> > > > unless she or he conscientiously takes refresher courses.
> > > >
> > > > Rehabilitation was a known factor from years back (I still remember
> an
> > > old
> > > > film we watched, made in England in the 1950s, which introduced the
> > > basics
> > > > of what we ended up doing for years), and it gradually gained
> traction
> > > over
> > > > time in my facilities. By the time I retired about ten years ago, the
> > > > strategy had become medication to stabilize and then a lot of day
> > > programs
> > > > of various types, designed to build on each consumer's strengths.  We
> > > > talked about the illness, how the consumer had to understand the
> nature
> > > of
> > > > their illness and learn to avoid trigger situations, and move toward
> > > things
> > > > that helped. Meds were merely a very beginning step.
> > > > Early on, I was taught that we expect the psychiatric patient to
> > require
> > > > constant medication to compensate for their chemical imbalance for
> the
> > > rest
> > > > of their lives.  As time went by, we found that was simply not
> true.  A
> > > > person can be acutely psychotic and then, after a robust
> rehabilitation
> > > > intervention, can learn to live a fairly normal life with reduced
> > > > medication. I had the pleasure of meeting and talking to some of
> these
> > > at a
> > > > psychiatric rehabilitation convention. I wanted to get these folks
> into
> > > my
> > > > facility; there's nothing so powerful as someone standing there
> talking
> > > to
> > > > a very ill consumer, saying, "I used to be right where you are now,
> > and I
> > > > took my meds, talked with my doctor, and went to programs, and today
> > I'm
> > > > working a fulltime job.  You can too."
> > > > I've seen some amazing accomplishments too -- folks I really never
> > > expected
> > > > to leave the facility did in fact get it together with the help of
> > > titrated
> > > > meds and the right programming.  We sometimes were able to do some
> very
> > > > good work.
> > > > By the time I retired, most physicians had bought pretty solidly into
> > the
> > > > rehab model, although the drug companies kept up their promotions,
> > > claiming
> > > > that certain difficult psychiatric patients could be cured with the
> > > > particular pill they were selling that month.
> > > > I was hired into a hospital whose Director was a psychiatrist (one
> who
> > > was
> > > > deeply committed to psych rehab, but still a psychiatrist). After
> that,
> > > the
> > > > head was an administrator who had come up through some other career
> > > ladder.
> > > > We have all those pictures of those psychiatrists (male, of course)
> who
> > > > used to be the director. Now, the pictures are just as often female
> as
> > > > male, and we have not had a physician director after the one
> previously
> > > > mentioned.
> > > > When I was hired in one facility, the sister facility across the
> county
> > > was
> > > > still directed by the old style director, and nurses generally wore
> > their
> > > > whites. I only saw a nurse in whites in the medical clinic. I can
> > imagine
> > > > that if I were to go to another state, things may well be very
> > different.
> > > > Sometimes, folks would say that New York State was the best of the
> > > best.  I
> > > > had to wonder, if we were "the best," then how was the rest of the
> > world
> > > > doing? We certainly had our share of dropped balls...
> > > >
> > > > So meds still plays an important part, and always will, but it's also
> > > only
> > > > a piece of the puzzle. Each consumer is a separate puzzle, requiring
> > her
> > > or
> > > > his own special interventions.
> > > >
> > > > James W. Oppenheimer-Crawford
>