Patient reviews should be banned in psychiatry.

[PikminOC]

Helps to have an SEO service that has closer ties to google.

How much is that? I'm just a solo pp

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[forchinet121]

So not refusal but for instance if there is lack of resource availability. If the patient is actually refusing to engage in treatment, then yes. But if you've got a patient where there is limited/no resource availability for higher levels of psychiatric care in the area, you can't just tell them you're going to discharge them and they have to wait to get into IOP for 6 months with no care. I mean I live in a relatively well resourced area for psychiatric care and for adults (less so for kids, can usually get kids into IOP/PHP/inpatient in a timely manner), I literally have most IOP/PHP programs telling me they aren't even putting people on waitlists because they have no idea when they'll have availability.

my understanding is you can discharge someone for any reason you want, as long as you give them their meds where are you getting the idea that you can’t discharge them? Now that I think about it..you can discharge them and don’t even have to wait for them to establish care as long as you give them like 2 months of meds…are you arguing that if there’s no other providers you can’t discharge any patients from your practice? You say “we are not a good fit, here’s a letter saying you’re being discharged from the practice and here’s 3 months of meds”

 

[calvnandhobbs68]

Dude yea you can..you can discharge someone for any reason you want, as long as you give them their meds where are you getting the idea that you can’t discharge them? Now that I think about it..you can discharge them and don’t even have to wait for them to establish care as long as you give them like 2 months of meds…are you arguing that if there’s no other providers you can’t discharge any patients from your practice?

They can also complain to your state medical board for any reason. The state medical board can then investigate this which can be very not fun for you.

How do you think it's going to look for instance when you start noting that the patients condition is worsening in your records, there has been no indication that the patient has been disruptive or noncompliant but you just start feeling uncomfortable treating them via telepsych, you tell them this but they can't find any new psychiatrists in their area, and then you send them a 30 day discharge letter? Imagine then this person does go kill themselves on day 31 (technically 1 day after you terminated the doctor patient relationship) because they now have no psychiatrist at all and no resources. I don't see the defense of "they weren't my patient anymore, I discharged them because we "weren't a good fit"" being a great one. Their family now brings a board complaint and finds a malpractice lawyer and we can imagine how this plays out in real life. Wouldn't want to be in the hotseat in that deposition.

 

[forchinet121]

They can also complain to your state medical board for any reason. The state medical board can then investigate this which can be very not fun for you.

How do you think it's going to look for instance when you start noting that the patients condition is worsening in your records, there has been no indication that the patient has been disruptive or noncompliant but you just start feeling uncomfortable treating them via telepsych, you tell them this but they can't find any new psychiatrists in their area, and then you send them a 30 day discharge letter? Imagine then this person does go kill themselves on day 31 (technically 1 day after you terminated the doctor patient relationship) because they now have no psychiatrist at all and no resources. I don't see the defense of "they weren't my patient anymore, I discharged them because we "weren't a good fit"" being a great one. Their family now brings a board complaint and finds a malpractice lawyer and we can imagine how this plays out in real life. Wouldn't want to be in the hotseat in that deposition.

Ok so what’s your alternative? Are you suggesting you cannot discharge a patient in an area that doesn’t have any other psychiatrist to see them?

 

[randomdoc1]

How much is that? I'm just a solo pp

They're $2500 a month, but the flood of referrals you can choose from is priceless.

 

[randomdoc1]

Ok so what’s your alternative? Are you suggesting you cannot discharge a patient in an area that doesn’t have any other psychiatrist to see them?

with all due respect, I don't think that is what @calvnandhobbs68 is saying. But it does get very very dire.

 

[PikminOC]

They're $2500 a month, but the flood of referrals you can choose from is priceless.

For a cash practice?

 

[randomdoc1]

For a cash practice?

Insurance based practice.

 

[FlowRate]

They can also complain to your state medical board for any reason. The state medical board can then investigate this which can be very not fun for you.

How do you think it's going to look for instance when you start noting that the patients condition is worsening in your records, there has been no indication that the patient has been disruptive or noncompliant but you just start feeling uncomfortable treating them via telepsych, you tell them this but they can't find any new psychiatrists in their area, and then you send them a 30 day discharge letter? Imagine then this person does go kill themselves on day 31 (technically 1 day after you terminated the doctor patient relationship) because they now have no psychiatrist at all and no resources. I don't see the defense of "they weren't my patient anymore, I discharged them because we "weren't a good fit"" being a great one. Their family now brings a board complaint and finds a malpractice lawyer and we can imagine how this plays out in real life. Wouldn't want to be in the hotseat in that deposition.

This debate seems to be about how much of a reason you need to justify discharging a patient who is not stable. I deal with this with college students pretty often. If they're totally stable or need just minor adjustments, I don't mind seeing them for one or two telehealth visits while they're out of state. But if they're bringing up worsening symptoms, escalating suicidality (or bpd provocative suicidality), etc. then I'm going to tell them they need to seek care locally/can't manage those issues for them from out of state. Due to the specific nature of working in an HMO system, it doesn't usually get to the point of "formally" (sending a certified letter) discharging them but it's effectively a discharge or temporary discharge nevertheless. So "patient out of state, not licensed in that state, patient worsening and needs local care" fits similar criteria of the patient being otherwise treatment adherent and in worsening clinical status but it being the more-or-less right thing to do to discharge them.

 

[allantois]

This debate seems to be about how much of a reason you need to justify discharging a patient who is not stable. I deal with this with college students pretty often. If they're totally stable or need just minor adjustments, I don't mind seeing them for one or two telehealth visits while they're out of state. But if they're bringing up worsening symptoms, escalating suicidality (or bpd provocative suicidality), etc. then I'm going to tell them they need to seek care locally/can't manage those issues for them from out of state. Due to the specific nature of working in an HMO system, it doesn't usually get to the point of "formally" (sending a certified letter) discharging them but it's effectively a discharge or temporary discharge nevertheless. So "patient out of state, not licensed in that state, patient worsening and needs local care" fits similar criteria of the patient being otherwise treatment adherent and in worsening clinical status but it being the more-or-less right thing to do to discharge them.

I do think this scenario is quite different. For one you can refuse to see the patient based on the grounds that they are out of state and you are not licensed in the state they are in (which actually may be illegal to see them in this scenario and personally I wouldn't do it in the first place as I really don't want something to go south and then it would come up I didn't have the legal right to be seeing the patient). I live in a college town and see plenty of out of state college kids whose psych discharged them after they left for college