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I've recently had a spate of adults (22 y/o+) that have either a) never had childhood ADD/ADHD or b) stopped meds prior to starting college who have presented requesting ADD/ADHD treatment -- usually self diagnosed, new stress at work, feel like they can't focus, have trouble multi-tasking -- some of these are college grads, etc. or are now faced with office paperwork after a promotion and are struggling ---
2 recent cases have prompted this thread --
Had a young male that had moved from another state and wanted to establish care -- knew medications, doses, etc. -- went ahead and filled the script, and requested records; don't see the patient for about 2 months (given 30 day supply) -- shows up 2 months after first visit requesting 90 day supply citing copay costs, etc. -- Do a drug screen and refill one month (new to my practice, etc.), refer to psych -- drug screen returns a few days later positive for cannabis (illegal in my state) -- patient returns in one month, didn't follow up with psych, tell them I'm not writing until I get a negative UDS (we drew one that day) -- patient gets a little ugly telling me I'm interfering with his life, he's just trying to do right, etc. --- UDS drawn that day comes back positive -- discharge the patient from my practice -- likely seeking behavior.
Another case -- young male who stated he was on meds as a kid, no knowledge of med/dose -- start low dose Adderall after appropriate screening and draw UDS at first visit --- UDS is positive, patient comes back 6 weeks after initial visit -- states he was out of town x 2 weeks -- again, getting another UDS -- will refill based on outcome of UDS ---
Also had a female who self dx'd with ADD, tried a friends medication which "helped a lot", wanted meds that day -- told her that since she had 1) finished college with no problems 2) was not sleeping well 3) had just been promoted with more responsibilities and taskings, this was likely not ADHD and I would refer her to psych for further eval just to be sure, hence I was not going to prescribe -- she became a bit hostile and told me that she wanted a prescription-- told her I understood, but she was being referred to psych -- not a happy camper.
There's a part of me that doesn't even want to handle this and just send adult ADHD to psych for eval and initiation of treatment -- I'll handle them after that --- but then it's really not too hard.
I've had some conversations get ugly, had a few belligerent patients, etc. Being an employed physician, I'm always cognizant of how the partners are going to react if I wind up dismissing too many patients or get patient complaints.
How does everyone else handle this type of stuff?
2 recent cases have prompted this thread --
Had a young male that had moved from another state and wanted to establish care -- knew medications, doses, etc. -- went ahead and filled the script, and requested records; don't see the patient for about 2 months (given 30 day supply) -- shows up 2 months after first visit requesting 90 day supply citing copay costs, etc. -- Do a drug screen and refill one month (new to my practice, etc.), refer to psych -- drug screen returns a few days later positive for cannabis (illegal in my state) -- patient returns in one month, didn't follow up with psych, tell them I'm not writing until I get a negative UDS (we drew one that day) -- patient gets a little ugly telling me I'm interfering with his life, he's just trying to do right, etc. --- UDS drawn that day comes back positive -- discharge the patient from my practice -- likely seeking behavior.
Another case -- young male who stated he was on meds as a kid, no knowledge of med/dose -- start low dose Adderall after appropriate screening and draw UDS at first visit --- UDS is positive, patient comes back 6 weeks after initial visit -- states he was out of town x 2 weeks -- again, getting another UDS -- will refill based on outcome of UDS ---
Also had a female who self dx'd with ADD, tried a friends medication which "helped a lot", wanted meds that day -- told her that since she had 1) finished college with no problems 2) was not sleeping well 3) had just been promoted with more responsibilities and taskings, this was likely not ADHD and I would refer her to psych for further eval just to be sure, hence I was not going to prescribe -- she became a bit hostile and told me that she wanted a prescription-- told her I understood, but she was being referred to psych -- not a happy camper.
There's a part of me that doesn't even want to handle this and just send adult ADHD to psych for eval and initiation of treatment -- I'll handle them after that --- but then it's really not too hard.
I've had some conversations get ugly, had a few belligerent patients, etc. Being an employed physician, I'm always cognizant of how the partners are going to react if I wind up dismissing too many patients or get patient complaints.
How does everyone else handle this type of stuff?