Prescription Privileges and Standard of Care

It sometimes appears that there’s nothing left to say on this topic — yet there’s occasionally a new wrinkle.

One issue that comes up is whether having a client go for a medication consult is what’s called “standard of care”. Essentially, “standard of care” means that there is some consensus within the profession that minimally competent practice would include the action, in this case a medication consult. In other words, you’d better follow this procedure or open oneself to vulnerability to lawsuits.

Who determines standard of care? Currently when someone comes to us with major depression we are supposed to refer them to a psychiatrist. But how about these scenario? A woman is filled with anxiety due to financial troubles. Is the standard of care to refer to a financial advisor? A man comes with deep concerns about his religion. Is the standard of care to refer to a priest? Are we committing malpractice by exploring such questions without referring?

As usual, it depends. Psychologists, when working as psychotherapists, are duty bound to explore the psychological implications of their clients concerns, first and foremost. It may be that concurrently — or after such concerns are thoroughly explored — a psychologist should consider referring to somone with another specialty, be that a psychiatrist, member of the clergy, or financial counselor.

Psychologists are not giving up their area of expertise by occasionally referring out. Good clinical work often involves consulting other professionals, and always includes knowing the boundaries of one’s competence. On the other hand, referring out in a knee-jerk fashion probably is not good clinical judgment and may even speak to some laziness on a clinician’s part.

Kalea Chapman, Psy.D.


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Clinical Psychologist practicing in the Los Feliz neighborhood of Los Angeles, California.

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