Seriously, what should/could I do about a previous psychiatrist..

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DD214_DOC

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I honestly think I should do something about the psychiatrist I replaced. The more and more I see, the worse everything gets, and I have specific examples. I'm not really sure if I should, and wanted to see what others thought. If I should, what can I go about doing? This is just recently:



11yo male with ADHD and, “bipolar” (not really) who was started on Abilify and continued on it for 4 years without any attempt to taper. Now weights 140# with likely obstructive sleep apnea. OSA sxs have been present for approx. one year or more. These concerns were reported to the previous psychiatrist who did no further evaluation and never referred patient for a PSG or sleep specialist eval. In fact, parent stated I was the first physician to even ask more questions about his sleep problems. No labs had been checked on this kid since May 2015, and even at that time were abnormal.


9yo male with ASD and ADHD who was started on abilify titrated to 15mg daily and left on it for the past 3-4 years. During that time, had onset of “tics” and other involuntary movements worsened over time. Currently, I am pretty sure he has TD. This was never discussed with parent.


10yo male, previous psychiatrist inexplicable ordered a CBC amongst other labs for unknown reason approx. one year ago. CBC returned as abnormal, with low Hgb/Hct, abnormal MCV, and review by pathology who recommended additional labs to include an iron panel and, if normal, plasmaphoresis for thalassemia. Pt had notable c/o fatigue. Psychiatrist reported to parent that labs were NORMAL, documented NORMAL labs in the chart, did not order f/u labs and did not refer patient back to PCM for additional evaluation. I had to discuss the results with mom, repeat the cbc with f/u iron panel, and then refer back to primary care for further eval/tx if needed. Oh, yeah, surprise dad has a thalassemia which I easily found out by simply asking.


This list could go on and on and on. I haven't been out of training very long, but this is borderline negligence to me, if not clearly crossing that line.

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Hmm, I don't have any experience with reporting physicians to the medical board, but I would think that they would take your concerns seriously and investigate your complaint of negligence. Is there enough there to lose his/her license? I'm not sure, I'd doubt it unless the board has had numerous other complaints.
 
Well there is the patient's report, the psychiatrist's report, and the truth. In due time you will have patients trash talk you and make you seem like the most incompetent psychiatrist to their next doctor. My suggestion is you collect all the facts before you make up your mind. There is a lot of incompetence out there but not all of it is. I get your frustration though-- this is part of the job.
 
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You can tell the parents to report. Give them the contact information of the state medical board. The problem with reporting yourself is you're hearing this based on hearsay.
 
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What the patient tells me and what they tell the psychiatrists are often two different things. It seems to be especially prevalent in parents who have kids with serious behavioral problems. They tell the psychiatrist that the quetiapine is the only thing working at all and then they tell me that they can't believe that the psychiatrist is recommending continued use despite 50# weight gain. I tell them that they need to stop reinforcing the negative behaviors and they tell me that the psychiatrist said that won't really work. Then the psychiatrist's note says that they told parent to stop reinforcing negative behaviors. Too bad we can't file a complaint with the parenting board.
 
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Unless you have true evidence of malfeasance, I'd leave it alone. You risk being sued for defamation and having this docs friends get retialiatory and run to the board. Hindsight is easy, you weren't in the room during these encounters. Also, if you report every lazy psychiatrist you follow up, you will be calling the board a whole lot.
 
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Well there is the patient's report, the psychiatrist's report, and the truth. In due time you will have patients trash talk you and make you seem like the most incompetent psychiatrist to their next doctor. My suggestion is you collect all the facts before you make up your mind. There is a lot of incompetence out there but not all of it is. I get your frustration though-- this is part of the job.
What the patient tells me and what they tell the psychiatrists are often two different things. It seems to be especially prevalent in parents who have kids with serious behavioral problems. They tell the psychiatrist that the quetiapine is the only thing working at all and then they tell me that they can't believe that the psychiatrist is recommending continued use despite 50# weight gain. I tell them that they need to stop reinforcing the negative behaviors and they tell me that the psychiatrist said that won't really work. Then the psychiatrist's note says that they told parent to stop reinforcing negative behaviors. Too bad we can't file a complaint with the parenting board.

Eh, he replaced the old psychiatrist so I'm assuming he inherited all the old records, which should make it pretty clear what happened over the time he's seen these patients especially in regards to lab results, medication dosing and side effects. If he never documented it, it never happened or if he documented incorrectly, it happened incorrectly, at least from a medico-legal standpoint. It's not like he's hearing this second hand from patients about a different psychiatrist.
 
Well there is the patient's report, the psychiatrist's report, and the truth.
The truth, in the one case, is in the lab report.
In due time you will have patients trash talk you and make you seem like the most incompetent psychiatrist to their next doctor.
There is no indication than any patient said anything negative about the previous psychiatrist. From the original post, all of this is based on what the previous psychiatrist did according to his own records.
The problem with reporting yourself is you're hearing this based on hearsay.
When are doctor's notes hearsay? The OP mentions nothing about a patient complaining.
 
Unless you have true evidence of malfeasance, I'd leave it alone. You risk being sued for defamation and having this docs friends get retialiatory and run to the board. Hindsight is easy, you weren't in the room during these encounters. Also, if you report every lazy psychiatrist you follow up, you will be calling the board a whole lot.

I think I'm here, too. While this is poor care, I'm just not sure that this is egregious enough that I'd take it to the board. I suspect the board would ignore it anyway. I'm just thinking of my brief time in community MH where I wound up doing all sorts of non-ideal things. I tried to document why, but then you wind up spending your whole life documenting.
 
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So, some points of clarification. I never ask patients about the previous psychiatrist, but many of them (most actually) volunteer complaints because they are very surprised at how different I am. The usual issue is that medications were not changed despite parent concern or request regarding side effects (many of them just ended up having to d/c on their own by googling how to do it), did not address specific and repeated concerns about side effects or other symptoms, and would tell patients how they felt and document what she told them as their status, even if the patient disagreed or reported otherwise. This is a consistent complaint I have seen. Now I realize this is just patient report, but patients who had been documented as improved and doing well who could have returned to primary care or be seen less frequently in reality had never improved or even worsened. I get it's just hearsay and not much I can do it about this aspect even though it's annoying. This person was also routinely NOT doing informed consent, as parents are astonished at the potential side effects of the meds their kids are already on and become angry about it; many have said they would have never agreed to the medication if they actually knew the effects.

The other stuff, however, is what I am exploring options for. Documenting abnormal labs as normal and not informing the parent that they were abnormal, and no documentation in the record of how it was addressed (it wasn't since it was documented as normal). Allowing patients to remain on medications that are not standard of care for their diagnosis for several years despite significant and worsening side effects that went completely ignored and were never addressed. It's this type of stuff I'm most concerned with.

I wouldn't report her to the board, and I don't plan to make a giant fuss about it. I don't have time to deal with that mess or any interest in creating a fiasco. I'm thinking I, at the very least, should contact whoever their current supervisor is (I know where the person went and personally know their current boss) and let them know that I have concerns about the care this person was providing here and that they may want to consider reviewing their work or something, or at least to keep an eye on them.

*shrug*
 
you need to really drop this whole angle and just worry about doing a good job yourself. That's all we control. And honestly, nothing you really mention rises to the level where a state medical board would want to know. The last thing is probably the most worrisome, but thats more an issue for his malpractice company(he never should have ordered the lab in the firts place...opened up a can of worms) in the future if he continues too practice that way.

Things like overprescribing to cause EPS and metabolic issues are NOT issues that can be reported to the board. If you start reporting that to the board you are going to be reporting a heck of a lot of people....and pissing a heck of a lot of people off for no good reason(and they will retaliate in some way most likely...as they should)

The only thing I would report to the state medical board was if I had strong evidence a provider was sexually abusing a young minor child or something like that. Crap like irresponsible prescribing habits doesn't even come close to making the cut....
 
There are always patients who will not do what you recommend. But if you see a patient for 15 minutes every 3 months and you don't have access to health system medical records, then as your patient panel size increases then what you are mentioning happens. This may be case of a poor clinician in a bad system, which is not uncommon.
But making mistakes or missing things and catching them 6 to 12 months later if you see the patient every 3 or 6 months could happen with anyone.
 
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I have only reported on one doctor to the medical board, ever. It was someone prescribing multiple benzos (all at high doses), seroquel, trazodone, and benadryl to a severe alcoholic who was literally stumbling drunk when I would see him (homeless guy in a shelter).

The patient ultimately died.
 
I have only reported on one doctor to the medical board, ever. It was someone prescribing multiple benzos (all at high doses), seroquel, trazodone, and benadryl to a severe alcoholic who was literally stumbling drunk when I would see him (homeless guy in a shelter).

The patient ultimately died.
Did the medical board take any action?
 
They said they were going to investigate. I checked the board database and there's no disciplinary actions noted. So no, no action.
It seems like the bar for action is pretty high, and in Virginia the action is usually training/counseling, etc. There was a doctor in my office who prescribed scheduled substances to secretaries and paid them to get the meds filled for him, which he then personally used and also gave out as samples to patients. His reprimand included a three-day course on proper prescribing techniques. He kept his license. I would share the order because it's kind of an unbelievable read, both in what he did (in addition to the above, he prescribed Adderall to a colleague for weight loss with no doctor/patient relationship, prescribed Xanax to another, and prescribed many meds to his family) and what the board didn't do, but I'm guessing that's probably a bridge too far. What was kind of amazing is that the board decided to only give him a formal reprimand based partially on letters written in support of him from the office staff--which is the same staff that was doing drug deals with him.
 
It seems like the bar for action is pretty high, and in Virginia the action is usually training/counseling, etc. There was a doctor in my office who prescribed scheduled substances to secretaries and paid them to get the meds filled for him, which he then personally used and also gave out as samples to patients. His reprimand included a three-day course on proper prescribing techniques. He kept his license. I would share the order because it's kind of an unbelievable read, both in what he did (in addition to the above, he prescribed Adderall to a colleague for weight loss with no doctor/patient relationship, prescribed Xanax to another, and prescribed many meds to his family) and what the board didn't do, but I'm guessing that's probably a bridge too far. What was kind of amazing is that the board decided to only give him a formal reprimand based partially on letters written in support of him from the office staff--which is the same staff that was doing drug deals with him.

yes....the bar is VERY HIGH for the state board to get involved. I mean you really have to be running an outright drug operation in the opening(and still this usually doesnt draw attention) or sexually abusing patients(this will draw attention). Given this, under no circumstances should we be reporting other psychiatrists for just being bad psychiatrists.
 
Around 1 in 10 physicians will receive a complaint through the medical board every year. At my CMHC pretty much every psychiatrist and nurse practitioner has had an investigation. Document! Document! Document! :)
 
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The problem with some of these places is that administrators tell patients to go straight to the medical board rather than work on a resolution. It's like do you realize we are not going to keep working for you if that keeps happening?
 
Sounds like a similar situation here. They'll investigate claims of misprescribing, treatment that falls below the accepted standard, and so on, but even in cases where action is taken it seems like a) A healthcare professional has to be off the charts incompetent or handing out controlled substances hand over fist for any action to be taken, and b) There doesn't seem to be any real consistency in the penalties handed down.
 
The problem with some of these places is that administrators tell patients to go straight to the medical board rather than work on a resolution. It's like do you realize we are not going to keep working for you if that keeps happening?

And that's exactly the sort of BS that wastes the medical board's time and makes it more difficult for legitimate complaints to be heard and/or taken seriously.
 
The problem with some of these places is that administrators tell patients to go straight to the medical board rather than work on a resolution. It's like do you realize we are not going to keep working for you if that keeps happening?

Wow, that's infuriating. If these administrators want you to keep on working for them, they should change their advice.
 
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When I was an intern, there was a community psychiatrist that we rotated with for the MH part of "educational requirements". He was diagnosing people with PTSD and then would start them on Klonopin 0.5mg QID and Xanax 0.25mg TID - "To help cover when Klonopin was wearing off until their next dosage."
 
I love SDN. Every time I think I'm a crappy doctor, I come on here and feel immediately better.

I diagnosed someone with PTSD today too. Just one. I started him on lexapro and hooked him up with a therapist.


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When I was an intern, there was a community psychiatrist that we rotated with for the MH part of "educational requirements". He was diagnosing people with PTSD and then would start them on Klonopin 0.5mg QID and Xanax 0.25mg TID - "To help cover when Klonopin was wearing off until their next dosage."

Holy crap. I feel so smart.
 
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When I was an intern, there was a community psychiatrist that we rotated with for the MH part of "educational requirements". He was diagnosing people with PTSD and then would start them on Klonopin 0.5mg QID and Xanax 0.25mg TID - "To help cover when Klonopin was wearing off until their next dosage."

eh....well at least he is using a lot lower doses than many outpt psychs treating ptsd.
 
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