To me those last two are the most important and personally, I don't want a job where I am doing either of those things. Dispo planning is a nightmare. I engage the patient in it and discuss it with my SWers but damned if I will be calling NH or setting up OP and coordinating with all the OP elements. That is what I did as a resident but IMO that is not what our long medical schooling and our education was training for. Calling collateral also a massive time suck for sure so personally, I limit it to only when the family is not happy with what they have heard or for some reason they dont trust hearing it from others on the team. But you absolutely need a good team set up for this. I worked at a VA for a little and nursing wouldn't even put in orders for dc without complaining even if we had been discussing dc at every tx plan meeting. I also would have to create notes that made the dispo documents which was tedious and easily could be completed by someone that had never set foot in any post HS training. In my eyes, things like that are just not a good use of our level of education. But I do realize some love being embedded into every aspect but that will for sure cut down on the number of patients you can see and treat.
For those who do inpatient quickly - how?
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As an inpatient attending who never calls outpatient doctors or asks for previous records (99% of the time), this sums up my thoughts perfectly. The only time I'm asking for records or calling another hospital/outpatient clinic for collateral is if I need to know if a patient recently had their LAI. Sure there are very rare exceptions to this rule, but they're just that: rare.
Does that mean that 99% of your acutely ill psych patients are able to provide sufficient history of their symptomatology and past treatment trials for you to be able to decide on most appropriate treatment for them? Or do you just have you favorite go-to meds for every condition without considering each case individually?
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That makes it disheartening to see all these job ads where they want you to see 18-20 patients a day, doesn't it?
At my hospital it is quite common for the nurses and/or social workers to tell us "so-and-so-'s [relative] called and would like a call back from the doctor." Do you not get these requests, do you just ignore them, or is your definition of "a good team" one that simply tells family "sorry, the doctor doesn't do that"?
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Yes.
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Bear in mind I'm saying this as someone who does work quickly (nowhere near as quick as most in this thread) but happily gets collateral in tricky situations. I can easily do 8-12 in a half day but would struggle to do 18+ on a weekday persistently. (99% of relevant history / collateral can be obtained by having a log in to the EHR the CMHC system, Psych ER, or chart review). I'm not saying this to be adversarial but really to ask you why you have this stance and aren't considering that the doctors you disparage are just as well (if not better) trained than you are.
Do you have any evidence at all that choosing a specific antipsychotic based on factors other than degree of sedation / most common AE and availability of an LAI has any difference at all when it comes to IP level of care?
There has never, ever, ever been a study that claimed you could spend 30 more minutes on an encounter and make a rational choice between Risperdal, Invega, Haldol, Prolixin, or Abilify for an acute psychotic state in the setting of someone having abruptly stopped their PO meds.
Same thing with deciding among Fanapt, Latuda, Rexulti, Caplyta, or any other expensive option without an LAI availability.
Are you talking about starting clozapine, the only drug that really has any evidence at being better than the others for specific populations? Because that does require some coordination with outpatient...but that's not the IP psychiatrist's job to ensure that the OP team knows clozapine is being started.
If the patient really cannot say anything about their medication history and really cannot voice a single symptom due to their severe disorganization - it doesn't matter which drug you pick, except for if you think clozapine or high dose benzodiazepines are appropriate. Neither requires you to speak to an OP provider, though. Hopefully you learned enough in training to be capable of being the OP or IP doctor in that situation. The frequency of patients so profoundly ill that a cromulent history can't be obtained is so low that it's surprising you're acting as if it's common. And I say this as someone who took care of almost exclusively profoundly psychotic patients in my inpatient years. Nearly every patient can say "no I don't want Haldol, that made my jaw hurt" or "no I don't want Zyprexa, I got fat." And if they can't say that Zyprexa made them fat, you can tell because they're fat. And if their OP doc knows that they can't tolerate Zyprexa long term, then the OP doc will just switch it to something else once the patient is out of the hospital. The goal of hospitalization in acute, short-term hospitals is not to be the end-all, be-all of that patient's life. It's to help them through the crisis to the point where the crisis can be managed in the community. That doesn't take a 60 minute intake with 60 more minutes of phone calls. That takes choosing the right class of tranquilizer and giving it to the person for 3-5 days and accepting that the real recovery happen elsewhere.
We can say the same thing about bipolar disorder, using those same drugs, just add in Depakote, lithium, and maybe Trileptal.
I will gladly reverse any statements above the second you show me any evidence beyond "I feel better when I take more time / ask someone else about it / I'm better than those other doctors who take less time / there's a magical property to having called someone who's too busy to be interrupted by a phone call that could have been prevented by faxing records directly to the OP team."
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It isn't that challenging for the staff member on the phone to empathically explore why the family member requires that a doctor call them back instead of the nurse who has been spending more time with the patient. Families generally just want someone to listen and convey that their loved one is being taken care of. It takes all of 30 seconds to ask why they're insisting on the doctor calling and satisfying their need to know someone has seen the patient today.
Granted, whenever this happened (less than one person per day IME on acute units) I did call while in residency. That was more for my own benefit than the family's or patient's, though.
Even ICU doctors aren't expected to meet with family members or answer their questions directly during the day. Half of nursing school is training them to be good at attending to the needs of family and caregivers, including communicating on behalf of the doctors.
The belief that only the psychiatrist can effectively say something feels to me to be steeped in arrogance and a lack of understanding of the roles of various healthcare team members. This stance is often what's holding the other team members back from performing their role.
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This is a great example of what I'm talking about. Just own your decision to not talk to families. Don't put down those that do this as being arrogant or lacking some understanding.
hippopotamusoath
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I think failure to coordinate with the outpatient psychiatrist is still pretty universally considered below the standard of care. I am too lazy to dig out my APA forensics textbook, but there is some nice discussion about what generally constitutes standard of care. The forensics people who post here are going to have a more accurate take, but my memory is that there are many cases where the malpractice argument hinges on failure to coordinate care.
My personal policy is that if you have an outpatient doctor, I'm making an attempt to reach them 100% of the time. Nearly always yields useful information.
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I am almost never going to try and make specific medication recommendations to an IP doc for one of my patients (not never, but rarely).
However, when you discharge someone I haven't seen in a year to me post-serious suicide attempt without attempting to even confirm that I know the patient, much less have an appointment for them earlier than a month out, you done goofed, IP.
If you start someone on lithium or clozapine or anything thing that truly requires monitoring and then blithely send them back to their providers without even checking to see whether providers in question are willing or set up to continue the required monitoring, you done goofed, IP.
If you really only see the job as pharmacologically snowing someone for 3-5 days until they stop making dangerous-sounding statements, okay, sure, who cares who you call. Also, what is your value add beyond a vending machine for neuroleptics or a clinical pharmacist with an algorithm and a tech administering a SCID?
However, when you discharge someone I haven't seen in a year to me post-serious suicide attempt without attempting to even confirm that I know the patient, much less have an appointment for them earlier than a month out, you done goofed, IP.
If you start someone on lithium or clozapine or anything thing that truly requires monitoring and then blithely send them back to their providers without even checking to see whether providers in question are willing or set up to continue the required monitoring, you done goofed, IP.
If you really only see the job as pharmacologically snowing someone for 3-5 days until they stop making dangerous-sounding statements, okay, sure, who cares who you call. Also, what is your value add beyond a vending machine for neuroleptics or a clinical pharmacist with an algorithm and a tech administering a SCID?
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Correct, what is your value added over an NP who I can teach to use all of the 10 meds you commonly use on inpatient?
And the whole crap about “if I start the wrong med the outpatient doc will just switch it” is hilarious. So just punt the buck to outpatient huh? I mean again you’re not exactly proving your value add here. Start everyone on Zyprexa and call it a day. People understandably have questions on outpatient why you’re switching their entire medication regimen around and why the inpatient team didn’t do that in the first place. Doesn’t invoke a lot of confidence in inpatient if they have to go back again.
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1) Giving people bipolar diagnoses that don't have bipolar. Proceeding to put on antipsychotic
2) Putting people on benzos when OP doc doesn't prescribe, or patient has addiction history, or was just taken off them, or ... or...
3) Put on name brand expensive medication that requires prior authorization as first choice when no other generic was tried first... who gets to clean up the mess? OP doc does. But what happens in real world is patient just stops it due to costs and is back to square one. I see this more with ARNPs thinking newer is better
4) Putting people on vivitrol and not confirming before hand that their Psych/Addiction office can facilitate administration... or their PCP office... or a pharmacy in area with PharmD willing to do the poke.
5) Patient just needs brief crisis stability of safety of locked unit. Very nuanced patient with long history. A plan is already in place, but simply need the inpatien unit to expedite dosing escalation faster than what outpatient venue can do. An easy, easy admit and plan. Patient speaks up, nope, DGAF doc and ARNP minions, stamp bipolar, and change the entire med regiment. Thanks for wasting an admission and setting patient up off worse than prior.
6) One tricky pony doctors. Use the same meds for everyone. Buspar... one older, came back from retirement doctor, put everyone on buspar and some other medication.
7) Not listening to patients outright, or patient just has such poor recall with stress of admission, they repeat a med trial... that was complete failure for reasons XYZ - patient gets discharged and reasons why was complete failure manifest again after discharge. Back to square one.
As a resident back in the day, I had small handful of psychiatrists who I was able to get ahold of and adequately informed me more about their patient, pitfalls, and what they hoped for meds while IP. Most of the time, even if not what I would have done, was reasonable. I discussed with patient, your doc wants XYZ. They would be like yeah, I like that plan. Boom. Rapport, engagement, and motivation for recovery. Less so, a patient on benzos, I would say I intend to taper off, doc says nope, I'll continue. I saved myself headache of taking off, because doc wanted on, and was going to hit refill anyways. Saved myself a headache.
*And to top it off, having worked at the top two most likely places of admission in the past, the staff there know how Sushi rolls... And that I will return their calls and return their faxes promptly. Some of the docs even have my cell phone number... but no. They still don't reach out.
2) Putting people on benzos when OP doc doesn't prescribe, or patient has addiction history, or was just taken off them, or ... or...
3) Put on name brand expensive medication that requires prior authorization as first choice when no other generic was tried first... who gets to clean up the mess? OP doc does. But what happens in real world is patient just stops it due to costs and is back to square one. I see this more with ARNPs thinking newer is better
4) Putting people on vivitrol and not confirming before hand that their Psych/Addiction office can facilitate administration... or their PCP office... or a pharmacy in area with PharmD willing to do the poke.
5) Patient just needs brief crisis stability of safety of locked unit. Very nuanced patient with long history. A plan is already in place, but simply need the inpatien unit to expedite dosing escalation faster than what outpatient venue can do. An easy, easy admit and plan. Patient speaks up, nope, DGAF doc and ARNP minions, stamp bipolar, and change the entire med regiment. Thanks for wasting an admission and setting patient up off worse than prior.
6) One tricky pony doctors. Use the same meds for everyone. Buspar... one older, came back from retirement doctor, put everyone on buspar and some other medication.
7) Not listening to patients outright, or patient just has such poor recall with stress of admission, they repeat a med trial... that was complete failure for reasons XYZ - patient gets discharged and reasons why was complete failure manifest again after discharge. Back to square one.
As a resident back in the day, I had small handful of psychiatrists who I was able to get ahold of and adequately informed me more about their patient, pitfalls, and what they hoped for meds while IP. Most of the time, even if not what I would have done, was reasonable. I discussed with patient, your doc wants XYZ. They would be like yeah, I like that plan. Boom. Rapport, engagement, and motivation for recovery. Less so, a patient on benzos, I would say I intend to taper off, doc says nope, I'll continue. I saved myself headache of taking off, because doc wanted on, and was going to hit refill anyways. Saved myself a headache.
*And to top it off, having worked at the top two most likely places of admission in the past, the staff there know how Sushi rolls... And that I will return their calls and return their faxes promptly. Some of the docs even have my cell phone number... but no. They still don't reach out.
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A lot of people seem to be describing how bad doctors are fast. Bad doctors can be fast or slow. They might be a little related, but I have seen immense amount of effort going into arguing to support a person's pet (wrong) diagnosis or getting extremely enmeshed in a personality disordered patient. In terms of inpatient to outpatient communication, ideally you will able to see the complete charting of the patient's outpatient course of treatment and that is what will make for a fast (good) doctor. The slow part comes when you have to try to arrange some sort of real time communication with their outpatient doctor. Personally, I did not find inpatient to outpatient communication helpful, when I was on either side of it, in the vast majority of cases. I concur with what others have said, obviously whatever was being done outpatient is not working.
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Where in my post was I disparaging anyone? I asked a question as I would love to learn to be more efficient too, as long as it doesn't negatively impact the quality of care I provide.
The rest of your post is addressed by other posters much more eloquently than I could.
Man I wish. But when I am told that someone's family member wants to speak with the doctor (the person leading the treatment team) about what their treatment plan is and why, saying to the nurse, "I don't have time for this, can you please empathically explore why they need to know that information?" is really not going to fly, at least not on the unit I work. The same with answering families' specific questions with "rest assured that someone did see your loved one today."
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No arguments here. I am sure you can be relatively fast and still do good work; as always, the idea isn't to spend a long time doing the work so much as spending enough time doing the work. Spending adequate time is a necessary but not sufficient condition for doing
I think there's room for more useful communication but if I got something like this reliably I'd be happy most of the time.
I make a point of calling IP units (or heck, EDs if I find out in time that a patient of mine is headed that way) and when I get through I usually seem to be giving them information that is a surprise. This is variably important depending on the case, ranging from "probably doesn't make much of a difference" to "plan-changing" based on feedback.
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I do inpatient psychiatry at several hospitals in the greater Memphis area. At my main psych hospital in northern Mississippi, I treat age 12 to 90+.
for the adolescents, I do call most of the families, and try to respond to a "true guardian " if they try to get a hold of me. If the patient doesn't have a clear guardian - I usually don't talk to anyone until it is sorted out by staff/child protective services. Had a recent case in which a parent taking care of the child died, the other parent brought them in and signed them in to the hospital (for depression/si), and then later we found out that parent wasn't supposed to have any contact with the child. Lots of kids living with "aunts" etc, but we try to verify that we have consent from the patient's guardian before admitting. If child protective services is the guardian, I usually do not talk directly to them.
Usually don't talk to family of adults- I leave that up to SW or nursing. The exception is for a demented patient, in which case I will talk to family if they want to talk to the doctor.
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Too real!!
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I document more in the subjective than most other inpatient docs I work with and document more of my medical decision making rationale in the plan than every inpatient doc I work with. I was told "Your notes are so long, I'm going to be honest I don't really read much except the plan when I cover on the weekends." A follow-up note takes me 3 min to dictate start to finish. H&P is around 5-7 minutes. I have blank templates that I insert and fill in as appropriate. Anything I find myself dictating more than a few times, I have a smart phrase in Dragon for it. I have ~15 different MSE templates that I chose from and update as appropriate for each patient.
Most of my day is spent chart reviewing before I see each patient and talking to nursing staff about how the behaved the day before. This allows me to tailor my daily interview to patient specific concerns. If you feel like you're moving too slow it might be a unit specific issue.
New intakes: On my unit each new admission is seen by ER psych, the ER physician, a behavioral health screener, and a nurse for intake. Most of the social history I care about has been established, so instead of asking them an open ended social history question I just confirm: "So I was reading that you just lost your job and are now living with your mom and her brother, is that correct?" [insert 1-2 min of empathy here]. Same with past psych history. The pharmacy system in my state reports every prescription filled from a Z-pak to Zyprexa on a database that I can review before seeing them, so instead of asking brand new I ask: "So I see here you've been on Prozac, Zoloft, Buspar and Xanax before. Do you remember if any of those worked well for you? Do you remember what you were told you were being treated for?" etc etc. "I see here you told the screener you had a suicide attempt via overdose last year that put you in the ICU, have you had any other attempts?" etc etc. The examples go on and on with substance hx and family hx but most of the relevant information has already been gathered and I am just formulating it into a diagnosis and plan AFTER confirming the story with the patient.
Follow-ups: I read the nursing notes from day shift and night shift, then the social work notes, which 90% of the time includes collateral from family. I check the MAR to see if any meds were refused or restraints were needed. I check vitals. I check any incoming lab results. Then tailor my interview based on this information + the plan I discussed with patients the previous day. I don't work at a private hospital. I don't give two ****s if insurance is covering their stay. No one is pressuring my to keep people longer or discharge people who don't have insurance. Follow-up visits I have to make two decisions: is patient ready for discharge? Does patient need med changes? I got minimal real psychotherapy training in residency so I don't kid myself and pretend I'm the one who should be providing therapy at bedside on an inpatient unit.
I get in at 7am, and I leave by 1pm after lunch. If my social worker tells me that families want to speak with me, I call them the same day...on the way home, then update my note from my home computer based on what we discussed. If nursing has patient questions they will send me a secure message on our hospital app and I respond within 5-10 minutes, usually faster because I am way too tied to my phone.
If someone wants to pat themselves on the back and say that do a better job than I do because that round until noon and write notes until 4pm, bravo, go ahead.
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Very helpful. Thanks for listing your entire daily process. Looks like being able to dictate and having screeners/ED collect histories really contribute to efficiency. I’ll have to see if getting Dragon is possible where I am.
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Chart review is first thing done, but after the first day back on a unit typically doesn't take long and I would include that in the time for initially seeing f/up patients. I rarely call outpatient docs for many reasons. A large portion of the time the patient either doesn't have an outpatient psychiatrist or can't tell me who they are. How am I supposed to call someone who I have no information on? I would say 90% of the time when I did call in residency, I never heard back from them and on the rare occasions that I did it was 2-3 days later at which point a treatment plan should be well under way. Calls with family I think are actually more useful when family is responsive, but collateral is often unnecessary in terms of the overall treatment plan but may be helpful with picking specific meds.
Inpatient cases are also not typically all that complicated. By the time they land on the unit, what they need for stabilization is often obvious enough that much of the info you're assuming is necessary actually isn't, though it can certainly be beneficial. Imo it's far more useful to have the pharmacist reach out to pharmacies to get their med history
Again, if outpatient docs would reliably respond with useful info then I'd agree. If I know who the outpatient doc is, I'll have SW reach out and ask them to contact us, which they almost never do in any useful fashion. There's a few I'll reach out to myself because I know them, but otherwise this is almost always a futile effort. Let's also be real, a large percentage of inpatients don't have decent psychiatrists who communicate well or provide helpful info.
Do you think those acutely ill patient's outpatient psychiatrists will be able to give that history sufficiently? If you're really able to reliably obtain this info then either you're in a very privileged inpatient setting or you're spending way too much time trying to obtain it.
Well these just sound like crappy doctors, doesn't really seem like things or practices that are unique to inpatient psychiatrists...
I've been gradually learning to be concise in the subjective and document important points without writing out paragraphs on specific details of what the patient says. But if it's someone that I think I might have to take to court, I include as much detail as possible. Quotes of all the disorganized or threatening things they say tend to help, in my experience.
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The outpatient records can let you know what has been tried already, why it failed, whether there were adverse reactions, and whether anything has been particularly effective. It's hard to make the case that the patient's history doesn't matter (and a decompensated inpatient may not be the most reliable source). Good history just puts you in a position to make better choices.
I get them but a good sw or nurse can answer almost all their questions because it’s rare for a family to have a deep question on medication mechanism, exactly why a specific medication was chosen. Most questions will be what is the diagnosis, how are they doing, what is the average stay, what is after care. Great example we had a family blowing up the nursing station and sw wasn’t assigned yet nurse was saying I needed to call. I said we don’t have anything to update we are two days in not close to dc sw has not been assigned so we will wait for sw. Sw got assigned and called because at least one spot I work it’s their job to always call families if we have contact info. She was easy able to answer any issues during her collateral call and there were 0 issues. I call the worst families that are verbally abusive to my team or demanding etc. I’m more than happy to make those calls. So a good team is a good team that actually does their jobs well sorry you have an unfortunately jaded opinion
This was quite well stated
Why does a doctor need to coordinate with the Op doctor? Why is it a problem that a dispo planner send discharge records both with the patient and via email if it’s possible to reasonably get through to an OP office. That doesn’t seem like a task that needs to be done by a physician.
Psych doesn’t have many meds to start and if we start looking at what is actually effective and affordable then we aren’t can have more than 20 anyways so you’re creating a false argument with the 10 inpatient meds.
The regimen gets switched because they landed Ip meaning that well thought out Op regimen didn’t work.
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Yeah, you don't say that to the nurse after the fact, that wouldn't fly with most of them because they're coming to you with a question and you'd be avoiding the question by assigning them more work. What I said is for the nurse to do that BEFORE the nurse ever comes to you with the phone call. The nurse is empowered to empathically explore what's going on with the family. Then the nurse summarizes the interaction to you. No need for the nurse to come to you with something they were already trained to address. Putting them in a situation where they aren't able to practice nursing without a doctor's approval will in the long run make them even more burned out.
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But maybe it was just an issue of adherence to the regimen, so that aspect should get addressed instead of changing the meds. Maybe a new med was started and just needs more time, not other new meds. Just because they go inpatient doesn't mean it's best to make big changes.
And inpatient, you're just going to see them for a week. Quite a lot can come up after that, so coordinating with the person who will take over in that extended time seems most reasonable.
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I started to write a post that was basically exactly what you said but a bit more long winded. Totally agreed.
I'll also say I've had several patients go inpatient in the last couple of years who are new to mental health treatment, are super anxious about any change, and, in a way, seem to count the net number of med changes against the medical system (same with their family members.) Unnecessary changes with these cases really does a disservice to what can be a tenuous treatment relationship.
So moral of the story seems to be there are two camps in regards to speed on the industry unit.. those who do it quick and think efficiency doesn't mean you are necessarily cutting corners. And then those who go above and beyond and think a lot of the faster docs are providing less than ideal care.
Seems no matter which way you go, you're in company.
Seems no matter which way you go, you're in company.
That isn't the conclusion I'd encourage at all. Efficiency and number of clinical tasks pursued are the two main factors that determine time spent but they are seperate. You can be efficient and do little, efficient and do a lot, slow and do little, and slow and do a lot. I think you need to figure out if you're efficient or not and then decide which tasks you are going to pursue or not and then own all of it and hopefully not feel the need to criticize how other people approach things in order to feel good about your own decisions.
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Fast is only bad if you are sloppy. Try to focus on what you need to do and educate the patient that inpatient treatment is not a one stop shop for treating all psychiatric issues. Inpatient treatment is to stabilize and provide safety when one is at imminent risk. Real treatment start in the outpatient world.
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But an issue with adherence can easily still be a problem with the regimen. Maybe it was SE maybe too many med administration times etc. the way to figure this out….speak to the patient and see what they feel about their regimen. “Do you feel the medications you were taking OP work? Was there a reason you weren’t able to take them as prescribed?” You don’t need Op records to determine that.
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Well it doesn't sound like you can be convinced otherwise, but as an outpatient psychiatrist I can tell you that I have a more accurate record than most patients. I have a more complete and accurate list of past medication trials, including the reasons they were stopped based on what was said at the time they were stopped instead of based on recollection months or years later. I can tell you what side effects the patient is now complaining of versus the physical symptoms they've been complaining about for months before starting the new medication they are blaming. I see this myself, with patients inaccurately recalling what we did, why, and when. Without my record from when the issue happened, I would be convinced by them just as you will be
That is a very over-simplistic perspective, and at that point you may as well be replaced by AI, never mind a midlevel. I have this lecture I give on errors in logic that are common in prescribing decisions (I will be the first to admit it is derivative) and this is probably the most common one. I can understand when a patient says 'it got bad till they switched my meds' but as a psychiatrist this is really just not good enough. Particularly for something like psychosis, readmission could be related to 1) the illness course leading to a period of worsening symptoms that form part of the expected trajectory even in the context of being on the best medication regimen ; 2) psychosocial factors driving a diminished capacity to function in the current community environment that may not even reflect a worsening of the biological aspects of the illness; 3) a psychological process by which the patient is interpreting new needs for support, containment and nurturing that they anticipate will be best met in an inpatient environment; 4) a true worsening of the brain-based parts of the illness but potentially the result of a range of factors including non-adherence to the prescribed medication; an additional biological illness which can reduce cognitive reserve and lead to a superimposed delirium; the use of additional prescription medication which could impact the blood levels of the antipsychotic; the use of substances which could cause psychotic symptoms even in the presence of a medication which in other circumstances is effective, and lastly, the possibility that the chosen agent is no longer the most effective and requires a change or adjusted dose. Caring about this is one of the reasons why I go home at 1pm not 11am and only make 400k.
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For real. I don't have some crazy complex med regimen patient panel (since I'm 90% child/adolescent) and most of the PARENTS (much less young adults or someone with a significant psychotic/mood disorder impacting recall) wouldn't be able to tell you why we stopped some medication we tried a year ago or what happened with it unless the side effects were absolutely terrible. Many patients can barely tell you what medication they're on RIGHT NOW...."uhh it's that one that starts with a B and looks like a little tablet doc, you know what I mean right?"
TheRightMedication
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When I did inpatient I left outpatient docs my personal cell and I still only got called back half the time. Of those calls, 50% of them were the outpatient doc deferring to me with little to no input. Often that's fair, if I call to say "good news, I've got them on an LAI" there's not much to discuss.
Those few cases where an outpatient doc both returned my call and had something substantive to discuss with me were very helpful for patient care.
Those few cases where an outpatient doc both returned my call and had something substantive to discuss with me were very helpful for patient care.
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I totally get it (and sounds like you did this) but this is something that's easily punted off to the social work/unit secretary to actually find their outpatient doc info and give their office a call to let them know their patient is hospitalized, here's your direct phone number so I can call you back during lunch or a no show or something. Takes pretty much no effort on your part and a 5 minute convo could be super helpful for both of us. The inpatient doc knows my patient is in the hospital...often times I don't and on the off chance I do and try to have my admin assistant call over there she gets bounced around to the social worker and crap. If the outpatient doc doesn't want or bother calling back, great no skin off your back. It's a pretty low effort, high value thing to do.
I also give other doctors my personal cell and tell them to text or call me if needed whenever. Best way to do it, neither of us has time to waste playing phone tag.
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Most of my inpatient adults don't have a longstanding private psychiatrist. If they are lucky, they have a psych NP. many have been treated by a pcp perhaps also receiving a therapist. Some go (often noncompliant) to a community mental health center- in those cases a SW/nurse can often find out how many months and (what was) they're last antipsychotic injection, and some information about their other meds. Nurses usually do a pretty good job of verifying home med list (other than LAI) with pharmacies.
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This is probably the biggest issue that makes trying to chase down the outpt doc not worth it. It was pretty rare when I would actually get through to them, and exceptionally rare when the patient had been with them for any extended period of time (more than a year or two) to provide significant beneficial information. Typically, the patients where a really in-depth history would be most beneficial are the ones whre getting significant collateral info is the most difficult. Plus, a lot of the outpt docs whose patients actually end up inpatient seem to be the 15-minute med check types who don't provide anything that's very useful. Maybe this varies with others' experiences, idk.
Yes, I'll take whatever info I can get and having someone on the team reach out to the outpatient team/office is certainly worth it, but this is not something that I'm going to spend any real energy on. As I said earlier, it's been uniformly more beneficial to have pharmacists reach out and do med recs for collateral than to spend significant time trying to get ahold of outpatient docs myself.
