how much primary care stuff do you guys get involved in?

[deleted1100659]

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Just curious everyone elses take on it, stuff like htn, thyroid, hyperlipidemia, etc. I often prescribe metformin but I dont usually do too much else in terms of medical/pcp stuff.

 

[comp1]

I think most VAs expect at least light management of medical stuff by psychiatrists on an inpatient unit with the upside being that you can consult for nearly anything right away if it gets complicated. VAs don't typically have internists round like some of the private hospitals.

 

[Bartelby]

Very little. I monitor, educate and refer but typically do not try to take on a primary care role (the main exception being that manage medical issues on inpatient, with a low threshold to consult as needed). This means not typically prescribing antihypertensives, insulin, etc etc.

 

[nowaysanjose]

Do almost all of it on inpatient. The place where I’m at just has an NP come over if you consult medicine. I got tired of continually cleaning up their messes and just do it on my own now.

 

[deleted1100659]

in the outpatient setting, I feel like once you start managing certain things, it opens the flood gates and soon you become the default PCP, since patients start to have little incentive to obtain one

 

[Stagg737]

Outpatient I'll start meds to address side effects of our meds and refer them to their PCP for ongoing management. Metformin, topiramate, and/or melatonin for metabolic syndrome or a statin for antipsychotic side effects if needed. PDE5 inhibitors or other meds for sexual SE. I feel like if we're causing the issue we should know how to address it (or at least start to).

Inpatient side I do more. I typically won't start meds, but I don't have a problem adjusting meds like insulins or HTN meds. I always consult if I'm legitimately concerned, but if an immediate adjustment can avert a potentially emergent situation we should know well enough how to make minor adjustments acutely in the inpatient setting.

 

[J ROD]

I am inpatient and have FM support but often times I manage most issues myself unless it is something I do not like for example a rash in the groin. I have started cholesterol, BP, DM meds.. I also used to do pain management and find myself doing quite a bit of that. Most of the year I have residents managing things and many times I disagree with their care. Program one where you end up if you do not match kind of thing. Wish I could bill for medical too separately.

 

[deleted1100659]

hm makes sense. I do agree with starting stuff to manage SE. On the inpatient side I used to adjust more medications as everyone else stated, but I think that was largely because of lack of availability for someone else to manage it/acute care setting so it was more of a temporary thing. With outpatient, I feel as though its more easy to get locked into long term management.