Prescription Depiction

"Doctors Guarding Their Turf as Other Practitioners Push to Expand Services" (June 3rd) falls right into a trap that has been carefully prepared for the unwary. The trap equates psychologists with psychiatrists and mistakes the performance of technical procedures with the knowledge behind the performance.

California law allows designated officials police officers, county designees and psychiatrists the authority and responsibility to petition for the admission to a hospital of suicidal, homicidal or gravely disabled persons. These "holds" are not a guarantee of an automatic admission to a hospital, and a psychiatrist can "break the hold" immediately.

Psychologists had been allowed to break holds, but a number of deaths occurred when psychologists released patients, and the courts removed this power years ago.

To release a patient on a hold is not trivial and requires both clinical judgment and experience. Who has this experience? Psychiatrists. Who is trained to work in demanding hospital environments 24 hours a day? Physicians. I've paid my dues with four years of medical school, one year of internship, three years of residency in psychiatry and in passing state and national examinations.

As far as the phrase "the privilege to write prescriptions" goes, this truly trivializes the practice of medicine. When I write a prescription for Prozac or any other of 100 or so psychiatric medications, I have conducted a psychiatric interview, obtained a comprehensive psychiatric history, performed a mental status exam, asked about medical problems, allergies, other medications being used, obtained a drug and alcohol history, made a diagnosis, reviewed side effects of the medication with the patient and finally and only then spend a minute writing a prescription.

Would you get on a jet piloted by a skilled jet mechanic who had taken a quick course in piloting? Not me. When I get behind the wheel of my car, I put on a seat belt, not dental floss, even if it's very high quality dental floss.

Marc D. Graff, M.D.
Chair, Public Affairs
California Psychiatric Association

Misleading Number

I question whether Santa Monica's proposed Living Wage ordinance ("Santa Monica's Wage Keeping Eateries Out," June 3) is really just a minimum wage law.

The statement that more than 80 cities and counties have living wage ordinances may be misleading if some, most or all are classic Living Wage ordinances affecting only businesses contracting with the city, rather than an ordinance that affects all only certain businesses.

Also, it would be important to know whether the cited Michigan State University study by David Neumark included classic Living Wage ordinances or the kind in Santa Monica, which is really a minimum wage.

Alan L. Freedman
Santa Monica

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