According to James Randi, a skeptic who has debunked many claims of psychic ability and uncovered fraudulent practices,[205] mediums who do cold readings "fish, suggest possibilities, make educated guesses and give options." Randi has a standing offer of $1 million US dollars for anyone who can demonstrate psychic ability under controlled conditions. Most prominent psychics and mediums have not taken up his offer.[206]

Senses used by mental mediums are sometimes defined differently from in other paranormal fields. A medium is said to have psychic abilities but not all psychics function as mediums. The term clairvoyance, for instance, may include seeing spirit and visions instilled by the spirit world. The Parapsychological Association defines "clairvoyance" as information derived directly from an external physical source.[37]