Can we make a sticky for job critiques?

[finalpsychyear]

Genuine question: what liability are you worried about and how do monthly appointments protect you against that liability in a way that q3mo, for example, wouldn't?

I dont do controls. My cmhc banned all controls due to diversion at one of the brances. Dea investigated and essentially told the cmo that more follow up than 90 days was warranted and if it happened again their would be significant consequences. Another patient decided to start taking 2x the stim dose had had a cardiac event and sued. Multiple benzo overdoses. These were the non detailed version of what the med director passed down in terms of info.

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[FlowRate]

I dont do controls. My cmhc banned all controls due to diversion at one of the brances. Dea investigated and essentially told the cmo that more follow up than 90 days was warranted and if it happened again their would be significant consequences. Another patient decided to start taking 2x the stim dose had had a cardiac event and sued. Multiple benzo overdoses. These were the non detailed version of what the med director passed down in terms of info.

I imagine more frequent follow-ups were suggested because there wasn't appropriate PDMP monitoring/was lax prescribing/etc. Seeing someone more frequently doesn't stop them from filling in multiple places or using more than prescribed or selling their meds.

 

[finalpsychyear]

I imagine more frequent follow-ups were suggested because there wasn't appropriate PDMP monitoring/was lax prescribing/etc. Seeing someone more frequently doesn't stop them from filling in multiple places or using more than prescribed or selling their meds.

bottom line it is easier to manage having less controlled patients. If a clinic has 1000 patients on q3 month controls a lot of times they will miss/cancel etc appts and still get another 3 mo as they slip through the cracks avoiding pill counts, uds, etc. Its much easier to have a few hundred tightly controlled or not at all.

 

[FlowRate]

bottom line it is easier to manage having less controlled patients. If a clinic has 1000 patients on q3 month controls a lot of times they will miss/cancel etc appts and still get another 3 mo as they slip through the cracks avoiding pill counts, uds, etc. Its much easier to have a few hundred tightly controlled or not at all.

Well yeah of course it's way easier to have fewer controlled patients.

I feel like our discussion has diverged from what I said at first--relatively run of the mill stim (ADHD) patients with no specific reasons to be concerned for misuse or diversion--the sort of patients that you'd have in private practice. Why would you need to do pill counts, frequent uds, etc.? (Very rare situation for me to feel that's necessary.)

Sounds like your current practice setup (CMHC) is a very different population. But you were asking about private practice, not CMHC.

 

[calvnandhobbs68]

bottom line it is easier to manage having less controlled patients. If a clinic has 1000 patients on q3 month controls a lot of times they will miss/cancel etc appts and still get another 3 mo as they slip through the cracks avoiding pill counts, uds, etc. Its much easier to have a few hundred tightly controlled or not at all.

“Slipping through the cracks” is just being lazy and not taking 3 minutes to check PDMP or checking when they had their last appt. Nobody should be writing another 90 days of stimulants for someone who didn’t keep their 3 month appointment. Either don’t refill the stims or make them make a followup appt right there when they call in and give them exactly enough medication to get to that appt, with the understanding that this won’t happen a second time in a row.

You also shouldn’t have 1000 patients on controlled meds anyway unless you’re running an actual pill mill. I’m child psych so likely prescribe more stimulants than most adult clinics (unless you’re an “ADHD clinic”) and still nowhere near 100 percent of my patients are on stimulants