Health and Psychology

Psychologists learn what to do in therapy as part of an educational process that includes doctoral level of study, internship, residency or post-doctoral fellowship, and passing of a licensure examination.  The Americal Psychological Association has an Ethics Code which serves to provide practitioners both an aspirational element for practice as well as enforceable rules to set the minimal standards under which practice is to take place.

Standards of care exist iin other fields as well such as hospital care, nursing, pharmacy, medical care, and other aspects of patient care which come under regulation in California by the Consumer Protection Agency.

For psychologists in California, regulations provide standards for note taking, treatment guidelines, and assessment guidelines, for clinical practice.  When I review the notes from other practitioners for cases I may have to look up the professional standards of care for that profession.  Most standards of care require a description of the condition being evaluated or treated, objective evidence of the condition, clinical assessment of the condition, and the planned course of action. 

In reviewing notes from other professionals, sometimes vague non-descriptive terms are used rather than clinical terms, the objective evidence is sometimes just a restatement of what the patient has said, the clinical assessment is lacking other than a diagnostic label, and the planned course of action may be just "return to the clinic in a week or if not improved."

This does a disservice to the patient and to any other provider attempting to ascertain what was actually attempted in the course of treatment.  Some doctors and psychologists use rating scales or checklists to document the course of improvement or lack of improvement with a trial of treatment. Rating scales also give good information on baseline functioning on the specific area being assessed. 

Health and medical psychologists can develop screening measures and can use more formal assessments to help physicians with documentation of objective symptom control and issues which may relate to recidivism of symptoms.  For example I have a client that has been treated for recurrent major depression and generalized anxiety for years, with underlying medical problems that are chronic and keep depression and anxiety at relatively high levels.  By setting a tracking system in place, the client can be specific with the treating physician about symptoms that are not respondng to medication.  I can specifically target therapy to symptom improvement.  The client can get a better understanding of the process of treatment and what leads to increased symptoms.  This system allows for clear documentation of symptoms, diagnosis, and goals.  This type of system helps to keep physicians informed of ongoing issues which may impact prescribing or other adjunctive treatment apart from therapy.