Expanding the scope of clinical practice: The physical examination.

Abstract

Five clinical health psychologists at a major medical center successfully completed a 36-hr, graduatelevel nurse practitioner course in advanced health assessment. The psychologists were trained to conduct thorough physical examinations and evaluate medical histories. All psychologists successfully completed the course and reported high levels of comfort with their ability to (a) conduct physical examinations, (b) describe physical examination findings, (c) provisionally identify medical problems and generally abnormal conditions, and (d) make appropriate referrals to medical specialists, when necessary. The nurse practitioner instructors reported high levels of satisfaction with student mastery of course content. The psychologists and nurses both reported high levels of satisfaction with the student-faculty relationship.The scope of psychological practice has expanded dramatically since the initial push for licensure in the early 1960s. Since that time, psychologists have expanded their scope of practice to include hospital privileges and, more recently, have initiated efforts to achieve prescriptive authority at the federal and state levels. Psychologists now admit and discharge patients, assume total responsibility for inpatient and outpatient care, write inpatient lab orders, and manage health psychology inpatient units (James, 1996;James & Folen, 1996; James, Polen, Davis, & Garland, 1997). Within the Department of Defense, a cadre of trained psychologists prescribe independently at a number of medical centers. As psychologists take these treatment modalities into underserved and unserved areas, the need to independently provide necessary related services, such as conducting general medical histories and physical examinations before ini-tiating medication or admitting a patient to an inpatient unit, may become critical.Such services may seem beyond the scope of psychological practice. Although Cartesian dualism would suggest that the

Ethical Considerations for Military Clinical Psychologists: A Review of Selected Literature

“…Although clinical psychologists are trained to understand and apply ethical practice within their work, organizational and clinical obligations can occasionally conflict. This can be seen with the emergence of new areas of practice for clinical psychologists (e.g., Folen, Kellar, James, Porter, & Peterson, 1998;Gutierrez & Silk, 1998). However, it is also found in highly specific occupational environments such as in the military (e.g., Jeffrey, Rankin, & Jeffrey, 1992;Johnson, Ralph, & Johnson, 2005).…”

Psychological consultation and services in a general medical hospital.

“…Taylor (1990) and Morrison (1997) conservatively estimate that at least 10% of psychological symptoms are caused by medical or physical conditions. Barnes and Galton (1976); Folen, Kellar, James, Peterson, and Porter (1998); and James and Folen (in press) have offered data and clinical information to highlight how diseases may cause psychological symptoms. Medical colleagues generally understand that psychological treatment is an important part of the treatment of patients with a medical condition exacerbated by psychosocial stressors, preexisting anxiety, or depressive symptoms that increase with medical concerns.…”

Prescribing non-psychopharmacological agents: A new potential role for psychologists in primary care settings and specialty clinics

“…Training Health Psychologists for the Expanded Scope of Practice James, Folen, Page, Noce, and Britton (1999) and Folen, Kellar, James, Porter, and Peterson (1998) have described a training model that prepares clinical health psychologists to prescribe non-psychopharmacological agents, conduct health assessments, and utilize medical laboratory tests as the primary psychological assessment tool. The training curriculum is in addition to traditional health psychology postdoctoral training, and requires a preceptorship with family practice physicians.…”