first, he/she didn't follow you instructions , second , he/she may have PD d/o?? borderline?? Her pcp may have told her the reasons or she forgot?? third, her pcp never responses your request which I encounter similar situation often times. anyway, the worst part is the client does not follow instructions leading to serious consequences. Not sure besides documentation, what else can we do to prevent injury?? any suggestions??
1) The patient followed my instructions, but the PCP never contacted me back. Remember, I wasn't the one prescribing the benzos, it was the PCP, and the PCP contiuned to do so even after I told the PCP it wasn't needed. I faxed letters to the doctor's office, wrote a letter that I asked the patient to bring to the PCP (she said she was going to see the PCP a few days later), and called the PCP's office and left my cell phone number.
2) Her PCP may have told her reasons and the patient may have forgotten. Whether or not this is true, it has been my experience that a significant number of doctors do not explain the process to their patients. How do I know this? Well patient's claims may be exaggerated, but during consult service, most of requests for capacity were from patients who refused a procedure. When I asked the patient if the doctor explained the risks and benefits of the procedure, the patient claimed no, and when I explained it to them, they were open to the procedure. The doctor didn't document that he/she explained the procedure. This highly suggested there was no discussion.
This is very uncomfortable because we shouldn't be explaining the risks/benefits of the procedures to the patients if it's outside our field, and it's in essence dumped on us. Several doctors are of the impression that they don't have to talk to their patients, and that's psychiatry's job. No, everyone has to talk to their patients when explaining the risks and benefits of a procedure.
I would end such consults telling the patient that they need to discuss the risks and benefits with the doctor that ordered the consult and that while I did have some discussion with them, I was not treating them in that regard, nor knew all of the rationale behind the treating doctor's decision.
While a resident, I had about one patient a week who was dependent on a benzo or opioid and their PCP (per the patient) never once told the patient the risk of addiction and dependence with those medications. Further, the doctor gave it out for years with no apparent strategy that these medications cause tolerance, then that doctor upped the dosage gradually over time.
he/she may have PD d/o?? borderline??
This patient certainly had some cluster B issues. Let's just say, ahem, well it's kinda like the Jerry Springer show. She's involved in a relationship with a man who has long term relationships with other women. Each of the women hate each other, and hate that he sees the other women, but they will not break up with him. Very cluster B, and IMHO it's the basis of her panic attacks. They did not happen before she saw this man, however she does not meet enough criteria for an actual personality disorder other than perhaps NOS.
Not sure besides documentation, what else can we do to prevent injury?? any suggestions??
Document. If you write a letter to the other doctor, and they do not follow your wishes, there's only so much you can do.
You need to be careful because sometimes the doctor may have some rationale that actually makes sense, it's just that you dont' have the doctor's note in front of you and the patient might not remember.