Claiming your expert as an equal with referrers

I see a lot of what I call “a GP says” in supervision and online.

-A GP said I should be doing x therapy not what I’d recommended. Is she right?

-The GP diagnosed x but I think it’s y. I’m afraid to tell him

-A Gp told the client 6 sessions should be enough

-A GP said my client should be on medication because they are in crisis instead of seeing me

-A GP said he didn’t want me to use EMDR because it wasn’t evidence based

-A GP said I should be able to see this client, when I declined, is she right?

-A GP said the client should attend fortnightly but I think weekly is better.

GPs are welcome to their opinions about therapies. But therapists are the experts on therapy. GPs do not typically study therapy extensively or know how to deliver it. They may have little knowledge about any therapy other than manualised CBT.

Some GPs have little interest in mental health and may have done little beyond the training received at medical school. They may have no idea about the dose response rates of treatments for different disorders or that when in crisis in some therapy models a client may be seen multiple times a week.

As gatekeepers of the Better Access program the perceived sense power of GPs in the area of mental health has increased dramatically. Therapists, primarily psychologists, who rely on Better Access referrals from GPs seem to have become increasingly uncertain about their role in the relationship and nervous about educating GPs or sharing their opinion as if they were an equal at the table of shared care.

This seems to be more of a problem for people who have only worked in private practice in a post Better Access world. Working for private practice employers who hold “never upset the referrer” policies further cements the sense of inequity for some therapists. For those who have worked in publicly funded multidisciplinary teams, differing opinions between health professionals involved in patient care is something that has been experienced and learned to manage assertively.

If you’re anything like me, as a therapist you have studied and trained and read and trained some more to become expert in what you do. You don’t stop learning about mental health and therapy.

Don’t give away your expert because you’re afraid of challenging a GP and losing the referral relationship.

Don’t assume a GP knows more than you or that their assessment of the situation is better

for the client.

Don’t give away your expert because you get caught up in over the top doctor worship. This may have been taught in your family and be operating in your concerns about openly discussing your difference of opinion or feeling free to dismiss a GP’s opinion.

Stand your ground if you’re therapist knowledge tells you that you’re assessment is accurate.

Discuss with a GP in the spirit of collaboration and education about therapy if you think it would be helpful.

Or let the opinion slide off and go with what your assessment and formulation indicated.

If in doubt go back to the latest best practice information or consult with a colleague or seek supervision.

You have worked hard to become a therapist so it’s important to honour that knowledge and experience.

Claim your expert, don’t just give it away to a referrer.

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