Please note this post is completely independent of recent events with Jackson. This is a criticism of all physicians who need to refer out patients to psychologists who perform cognitive and psychological testing. Furthermore, this is a criticism of physicians using psychological screening devices inappropriately to make sweeping statements regarding patients’ psychological states. It would be equivalent to a psychologist reading some medical screener, then making a sweeping statement of physical health. I will make clear why a physician should be referring out vs. not referring out to psychologists. Also, making clear why they need to understand some of these these “tests,” “assessments” are screeners, and not powerful to make sweeping judgements.

Giving a screening device of this nature is totally within a physician’s scope of practice. Yet not okay to then make a sweeping statement of the patient’s psychological status. After all, this physician (and others) is/are medically trained, and psychologists are not. However to make a sweeping statement that the president is cognitively fully functioning is not okay. My criticism is that I wish he would have enlisted psychologists. Again, do not dismiss my points hereafter due to recent ethical charges against Jackson. That is the easy copout in a situation such as this. It is a pervasive problem therapists and psychologist come across in practice.

A patient coming in with diagnosis made by a physician based on some screener only is inappropriate. In the situation with the president a psychologist could have stepped in and assessed at a much more advanced level the president’s cognitive status. Psychologists do not assess the medical status of patients so I do not understand why medical doctors think they can assess complicated nature of cognitive functioning. We have psychologists where their entire careers are dedicated to assessments alone.

This is critical for the reader to know because if you go to a physician or bring in a loved you should know physicians are not at all competent to evaluate the psychological status of a patient. Just like if you go to a therapist/psychologist they are not at all competent to evaluate your physiological/medical status. If this were a case where a therapist/psychologist were making medical status statements I’d be just as critical.

This is not my opinion – both groups have ethical codes and principles of which indicate to practice within their scope of education and ability. The principles for physicians indicate to use other professionals when needed (Principle V). For psychologists it is under the section of Competence, part (b). These documents can be found online free of charge.

This paragraph is entirely my opinion. I believe that in the U.S. people deify physicians, as do other countries. Many people think that because a physician said the president is cognitively functioning at whatever status people believe it as accurate.

I elaborate in detail below.

No doubt Trump achieved a perfect score on the Montreal Cognitive Assessment. First off, it is accesible online by anybody, plus COACHABLE. Coachable in the sense that anyone reading this can access it right now! Then, practice it and you will get a perfect score, unless you have true cognitive impairment. Second, calling it an “assessment” gives it far more credit than it deserves. To psychologists it is a mere screener. This means if the person scores below a certain level (or above), then we give sophisticated assessments. Third, physicians, MD’s who do not have a PhD education CANNOT give the sophisticated assessments psychologists have. The assessments psychologists will give are not accesible online. Furthermore, these assessments take again a PhD level of training in psychology to administer/score/interpret which physicians do not have. As an example, the notorious IQ assessment takes a full semester course alone. Yes, technically one can achieve both an MD and PhD. However, this is rare to begin with. Most MD PhDs that you may have come across, which seems so lofty and impressive, have a related biological, chemistry etc. PhD. In these cases the courses and training overlap. I have never met someone who has achieved both back to back. I know they exist, yet are rare, and would be well over a decade of education and training to achieve.

What I am trying to say is that for a psychologist to hear Trump passed this specific screener is perfunctory. Then for a physician to make a sweeping statement of cognitive functioning is reckless and inappropriate. When you consider the president or anyone could have practiced this screener it becomes meaningless. I say this because we have numerous instruments that assess very specific cognitive issues. These are inaccessible to the general public and in many cases you cannot practice them anyways.

Examples include but are not limited to the list that is on the website: http://www.assessmentpsychology.com. Pull up this site you will be shocked! I was as well at the number of assessments we have, and I have been trained in assessments! Many of them REQUIRE a PhD level of training. Yes, on the site some are to be used for screening purposes by other professionals. A free screener can then be administered to literally hundreds of people at the same time. Then if any individual in a group falls below or scores above a certain level, they are then passed on to psychologists for further assessments. A good example would be an elementary school teacher giving to a class of 30 students a screener, something for ADHD, Depression, or Anxiety. Then if any student’s score is above or below (whatever number) then they are referred to the school counselor and or psychologist.

The take-home point is that Trump was administered a basic screener. So basic, for example it “tests” for short term memory, yet not other types. We have assessments for long term, working memory, auditory, visual, delayed types of memory and the list goes on! Trump may have long term memory issues, or any number of them.

Addressing “fit for duty” is a massive blog entry itself. Frankly, in my opinion fitness for duty should be multi disciplinary, not for psychology alone. However, once you look at the Montreal Cognitive Assessment, you notice in no way it assesses for:

Depression
Anxiety
ADHD
Narcissism
Anti-Social Personality Disorder
Learning Disabilities
Drug Issues
Autism spectrum disorders
The list goes on..

Any of these could be argued would impact “fitness for duty.” Again, that is an entirely different conversation.

Finally, shame on both groups for not stepping in. The American Psychological Association should have been jumping up down and on the news to point these basic facts to the media. The fact that a sweeping cognitive functioning generalization was being made based on a mere common screening device. The American Medical Association should have jumped in stating that referring out to psychologists would have been most appropriate.

Clearly, in summation, I believe that for any statement regarding the cognitive functioning, especially for the leader of our country, psychologists should be involved.