Dr James Schaller
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The Ethics Of Referring Psychiatric Problems: A Guide to Pediatric, Family Medicine, Internal Medicine and Gynecology Sloppiness in Brain Chemistry

Most of the research on the treatment of psychiatric problems being treated by non-specialists shows they do a fair job. My experience is that the studies do not pick up the half of it. I do not do brain surgery, since if someone is going to tinker with the brain, I want them to know what they are doing. Well that is what all psychiatric medications of every class do; they tinker with the biochemistry of the brain.

In the hands of someone who is an expert and who really understands all the many issues involved in attention, anxiety, boredom, etc, these medications can help the brain return to normal functioning. In the hands of a non-specialist, with 3 minutes to prescribe them, these medications can be a band-aid to cover one of 500 other medical issues. And even if there is a medical problem and psychiatric medications are needed for a period of time, the underlying issue should be sought out aggressively, not by 1990's medicine and a few tubes of organ failure blood testing.

Ethically, some medical and neurology groups like to keep having patients keep coming back to them for psychiatric disorders, because this keeps the money inside the group. It helps pay for their massive overhead and malpractice costs. And some agencies tell physicians that it would be good if they all learned how to treat depression. While that might be good if you have no options. But many USA communities do have solid child, adolescent and adult psychiatrists. Some non-psychiatrists writing brain chemistry medication scripts, simply do not have humility when it comes to this area. There is a reason physician's train many years to do adult psychiatry, and 2 extra years in child and adolescent psychiatry fellowships to treat children to mature college youth. It is because those specialist and sub-specialist trainings are needed to learn THE BASICS!

So I will leave the scalpel to the surgeons, and particularly the brain surgeons, but lets leave the brain chemistry to folks with the training who at least have a higher chance of doing it right.

To Your Best Care!

Dr. J



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