Kentucky Psychology Board Moves to Censure Advice Columnist

In an interesting twist on protecting the public, the State Board of Psychology in Kentucky has filed suit against John Rosemond, a North Carolina licensed psychologist who writes a syndicated newspaper column, for practicing psychology in Kentucky without a license.  Rosemond's collumn appears in more than 200 newspapers according to a post on the Institute for Justice blog.

Each state has the authority to regulate the activities of professionals who offer services to citizens of the state. Each board is established by the legislature of the state and interprets the laws pertaining to professional practice in that state.  As a Pennsylvania licensed psychologist, I am required to adhere to the standards and regulations put forth by my state's licensing board.  If I do not, I risk sanction or the loss of my license to practice.  Anyone who wishes to practice psychology in Pennsylvania must apply to the board for permission to do so.

That's where the rub comes in the Kentucky case.  It seems that Rosemond, who has written 14 books on parenting, offered advice on parenting to which one retired psychologist in Kentucky took exception and wrote to the Kentucky board to complain.

The job of any professional board is to protect the public from harm and in this instance the Kentucky board reasoned that Rosemond's advice constituted the provision of psychological services for which he was not licensed in Kentucky.

Potentially, this opens a whole can of worms if one accepts that advice given in a syndicated column constitutes provision of psychological services.  Writers from a libertarian perspective cry foul because this would seem to limit first amendment rights to free speech.

It's hard to know exactly what argument was made in the Kentucky case but licensing boards are generally quite careful to deliberate fully before making a move.  They try to talk through the potential ramifications of various steps and to interpret the law as clearly as possible.

Another problematic situation that many state psychology boards are trying to work out is how to regulate the provision of counseling via electronic means.  For example, let's say you decide to start working with Dr. X who practices in California because he is an expert in the treatment of a disorder that you have.  Because he is in California and you are in, let's say Pennsylvania, you decide to conduct your sessions through Skype.

So what state regulates this professional service, California or Pennsylvania?  Who has jurisdiction to prosecute Dr. X if you feel that he has acted unethically or committed malpractice?  One suggestion is to have a national "passport" or universal certification but this may run afoul of state laws that prevent states from relinquishing regulatory authority.

Whatever the answer, this issue is likely to come up more frequently as consumers increasingly look to electronic sources for healthcare.  Some studies are even finding that internet based psychotherapy is as effective as face-to-face therapy.  There will be more to say about that later.

Listening as Good Risk Management

I had an interesting conversation with a representative from my electronic medical record provider the other day.  We were talking about setting up a program in which the company would contact patients on my behalf to verify insurance information on claims that had been rejected, something I am bad about doing.  He mentioned that his company also does medical billing and that he was surprised to notice that psychotherapy patients were much more willing to talk about billing problems than were medical patients.  In fact, he said that medical patients were often defensive and unwilling to speak with his office whereas psychotherapy patients willingly worked with him to resolve billing problems.

It turns out there is a good reason for this difference. Because therapists spend so much time listening and directly spending time with patients, they form a stronger relationship with them.  For this reason, when someone calls asking about a bill for a service, the patient knows the provider and has a connection with that person.  The same is often not the case say, for a radiologist charge where the patient never even met the provider let alone have any connection with him or her.

In an interesting study (link to the study) about which physicians get sued for malpractice and which don't, Wendy Levinson M.D. and her colleagues found that getting sued did not just relate to poor medicine, in fact she found that doctors who got sued and those that had never been sued could be differentiated by the quality of their interactions with patients; their relationships.  She found that doctors who had never been sued (1) spent more time with each patient, (2) oriented patients to what was going to happen next, (3) used active listening skills, and (4) laughed more often with patients.

So it's really no surprise that therapists form stronger relationships with their patients and as a result they are less likely to be regarded negatively when things go wrong or when a claim gets scrambled.