prominence

Senior Member
15+ Year Member
Dec 19, 2001
1,072
16
351
Status
Attending Physician
For those psychiatrists working in the outpatient setting, how are medication refills and other medication questions (i.e. "medication isn't working", potential side effects to psychiatric medication) before the patient's next appointment handled in your practice?

Do you have a medical assistant or a nurse practitioner run the request by you, and then they call the patient back to respond to the question or they call the script into the pharmacy?

Or, do you need to personally check in with the patient via phone to respond to the patient's specific query? In the case of a refill request, do you call the patient to make sure they are tolerating the psychiatric medication and not having any significant side effects to the medication in question, and then do you have to personally call the script in yourself to the pharmacy (due to lack of medical assistant or nurse practitioner at your office to do this for you)?

I am curious about how this issue is handled at other people's practices. Thank you for any insights.
 

OldPsychDoc

Senior Curmudgeon
Moderator Emeritus
10+ Year Member
Dec 2, 2004
6,218
3,778
281
57
Left of Center
Status
Attending Physician
For those psychiatrists working in the outpatient setting, how are medication refills and other medication questions (i.e. "medication isn't working", potential side effects to psychiatric medication) before the patient's next appointment handled in your practice?

Do you have a medical assistant or a nurse practitioner run the request by you, and then they call the patient back to respond to the question or they call the script into the pharmacy?

Or, do you need to personally check in with the patient via phone to respond to the patient's specific query? In the case of a refill request, do you call the patient to make sure they are tolerating the psychiatric medication and not having any significant side effects to the medication in question, and then do you have to personally call the script in yourself to the pharmacy (due to lack of medical assistant or nurse practitioner at your office to do this for you)?

I am curious about how this issue is handled at other people's practices. Thank you for any insights.
This is why I enjoy being part of large group practice. The request, either from pharmacy or patient, is fielded by one of our pool of RNs, who validate it in our EMR as appropriate (e.g. a current med, correct dose based on last visit, not a request for a refill of klonopin 1 week afer refilling a month's supply :rolleyes:) by referring to our last note. They check for us whether the pt needs to be seen, needs labs, etc. If there's a question, they message us securely via the EMR. They can electronically transmit the script to the requesting pharmacy, and no trees die, no ink is spilled... Stimulants and benzos require some additional handling, but we have procedures to follow.

I would DIE in solo practice.
 

whopper

Former jolly good fellow
15+ Year Member
Feb 8, 2004
6,850
1,609
381
Visit site
Status
Attending Physician
I've discovered the same as well.

My moonlighting gig provides me with a nurse that does a lot of the scut, so I can focus on the cool stuff. E.g. she provides the patient with the pamphlets on the medications, asks them the questions she knows I will ask ahead of time (e.g. hours of sleep, vital signs, all the questions on a mental status exam--I still do them, but being able to read someone else's note before I start allows me to get to the heart of the matter much more quickly).

In solo practice, you're going to have to do these things on your own.

In terms of how much information you need to divulge to the patient, the legal answer is enough to reach a "reasonable patient standard" which is enough for a patient to understand the risks and benefits.

Warning, while there is a reasonable patient standard, and that standard does no including telling the patient everything, if you don't tell them a very rare effect, and it happens, the anger the patient may experience may make them not care about the standard. This could be understandable given the situation.

E.g. one doctor I know of, his patient went blind on Topamax (temporarily thankfully!). That doctor did not reveal that blindness was a possible side effect, though he did go down a reasonable list of effects.
 

thamsenman

Removed
Dec 14, 2009
992
0
0
Status
Pre-Medical
This is why I enjoy being part of large group practice. The request, either from pharmacy or patient, is fielded by one of our pool of RNs, who validate it in our EMR as appropriate (e.g. a current med, correct dose based on last visit, not a request for a refill of klonopin 1 week afer refilling a month's supply :rolleyes:) by referring to our last note. They check for us whether the pt needs to be seen, needs labs, etc. If there's a question, they message us securely via the EMR. They can electronically transmit the script to the requesting pharmacy, and no trees die, no ink is spilled... Stimulants and benzos require some additional handling, but we have procedures to follow.

I would DIE in solo practice.
You wouldn't become a drug addict would you? ;)