Psychiatrist just died, OK to self-prescribe?

[nooneinparticular12345]

So I'm a PGY-2 psychiatry with a long-standing mood disorder that I'd like to keep very much under wraps, and I DEFINITELY do not feel comfortable letting any of my co-residents or attendings know about this. I have been on the same mood stabilizer for 10+ years, completely stable with good monitoring and follow up.

I had a psychiatrist appointment last week, but my psychiatrist just died, and I really REALLY need a mood-stabilizer. There is obviously a shortage of psychiatrists, and the soonest I can get an appointment is several weeks out. There is a county walk-in clinic, but guess who staffs it? Our residents!

From the threads I've read, in general people seem okay with self-prescribing simple stuff, like antibiotics, but many of the threads specifically call out psych meds as being risky to prescribe to self or others (?). Many of the threads say to ask an attending or a friend to prescribe it, but in this case, I definitely can't ask - the stigma of mental disorders among psychiatrists is ironically extremely high.

I only have a training license, but if I don't get meds soon, something bad may happen. Think this is a reasonable case to self-prescribe? Any other suggestions?

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[wolfvgang22]

Can you take a sick day and drive to another clinic to get a Rx? If it's bad enough you are thinking about self prescribing it's bad enough to call in sick to take care of business. You may get away with self prescribing if a pharmacist allows you to do it, but it isn't the best solution. Don't prescribe yourself any controlled substances at all.

 

[wysdoc]

So I'm a PGY-2 psychiatry with a long-standing mood disorder that I'd like to keep very much under wraps, and I DEFINITELY do not feel comfortable letting any of my co-residents or attendings know about this. I have been on the same mood stabilizer for 10+ years, completely stable with good monitoring and follow up.

I had a psychiatrist appointment last week, but my psychiatrist just died, and I really REALLY need a mood-stabilizer. There is obviously a shortage of psychiatrists, and the soonest I can get an appointment is several weeks out. There is a county walk-in clinic, but guess who staffs it? Our residents!

From the threads I've read, in general people seem okay with self-prescribing simple stuff, like antibiotics, but many of the threads specifically call out psych meds as being risky to prescribe to self or others (?). Many of the threads say to ask an attending or a friend to prescribe it, but in this case, I definitely can't ask - the stigma of mental disorders among psychiatrists is ironically extremely high.

I only have a training license, but if I don't get meds soon, something bad may happen. Think this is a reasonable case to self-prescribe? Any other suggestions?

Contact your psychiatrist's office to see what arrangements have been made to cover care of patients following his unexpected death. Don't put yourself at risk for reprimands by trying to self-prescribe this.

 

[Stagg737]

Is there any way you could get in to see a PCP to prescribe it as a one-shot until you can find a new psychiatrist? Since you know exactly what you need to stay stable, I'd be surprised if another physician wouldn't write a prescription for you until you can get established with a new psychiatrist...

 

[OldPsychDoc]

^^^ What I was going to suggest.

 

[nooneinparticular12345]

Is there any way you could get in to see a PCP to prescribe it as a one-shot until you can find a new psychiatrist? Since you know exactly what you need to stay stable, I'd be surprised if another physician wouldn't write a prescription for you until you can get established with a new psychiatrist...

That is a most excellent idea. We have a walk-in student clinic staffed by our Peds attendings nearby. Given I have virtually no interaction with them, I think it'll be safe. I think most Pediatricians aren't too comfortable with mood stabilizers, but hopefully if I explain the situation they'll understand. Got a week of meds left *gulp*.

Thanks for the input!

 

[Unico]

Minute clinics at CVS or Walgreens have been known to do one-off refills, wouldn't hurt to try. GL

 

[FlowRate]

That is a most excellent idea. We have a walk-in student clinic staffed by our Peds attendings nearby. Given I have virtually no interaction with them, I think it'll be safe. I think most Pediatricians aren't too comfortable with mood stabilizers, but hopefully if I explain the situation they'll understand. Got a week of meds left *gulp*.

Thanks for the input!

This is a good reason to get set up with a PCP. You may never need them, but having a chronic condition is a good reason to have one--in case your specialist is unavailable and you're in need of refills.

If it comes down to day-0 and you're only looking for Lithium or Lamotrigine or something of the sort then it's definitely worth trying to self-Rx your usual dose and amount as a holdover.

 

[keifernny2]

Also, Urgent care clinic? I assume you have health insurance as a resident. If you're already on the med and bring your Rx bottles with you I don't see an issue.

 

[hamstergang]

I only have a training license

My understanding is that this means everything you do medically is actually under the supervision of some attending. If you self prescribe with a training license, you're practicing medicine unsupervised which would be very bad.

I could be wrong, however.

 

[nancysinatra]

Don't self prescribe in this situation. If you have a mood disorder, in some states, you could attract the interest of the state medical board just for that. If they learn you've self prescribed, they'll just be all the more inclined to give you a hard time. Go to a PCP like others have suggested. There are nurse practitioners galore out there who should be able to see you. Or go to the ER. I know it may seem shameful to go to an ER just for a refill, but people do it all the time, and all you need to do is confide in the ER attending what is actually going on, and they should understand.

 

[857770]

So I'm a PGY-2 psychiatry with a long-standing mood disorder that I'd like to keep very much under wraps, and I DEFINITELY do not feel comfortable letting any of my co-residents or attendings know about this. I have been on the same mood stabilizer for 10+ years, completely stable with good monitoring and follow up.

I had a psychiatrist appointment last week, but my psychiatrist just died, and I really REALLY need a mood-stabilizer. There is obviously a shortage of psychiatrists, and the soonest I can get an appointment is several weeks out. There is a county walk-in clinic, but guess who staffs it? Our residents!

From the threads I've read, in general people seem okay with self-prescribing simple stuff, like antibiotics, but many of the threads specifically call out psych meds as being risky to prescribe to self or others (?). Many of the threads say to ask an attending or a friend to prescribe it, but in this case, I definitely can't ask - the stigma of mental disorders among psychiatrists is ironically extremely high.

I only have a training license, but if I don't get meds soon, something bad may happen. Think this is a reasonable case to self-prescribe? Any other suggestions?

Your PCP might be an option. Just explain your situation, and he/she should be able to prescribe it for you.

 

[nooneinparticular12345]

So an update if you guys are curious.

I have no PCP, the only other docs I have seen other than my psychiatrist are at the student walk in clinic. The nurse at this clinic flat out refused me and wouldn't let me speak to a doctor, because it is their policy to not give refills to walk-ins. I also tried the family medicine walk in clinic and got the same response, not allowed to even speak to a doctor.
Went down to CVS, and I know the pharmacist pretty well. Apparently they are only authorized to give 3 pills w/o a prescription, but she gave me 20. Then I went to minute clinic, and the NP agreed no problem to a one month supply refill, but stated I'm only allowed one 30 day refill per 12 months.
Finally, got an appt with a psych NP for 3 weeks out, which is pretty good considering the circumstances.

Moral of the story: get a PCP, CVS rocks, and our mental health population really underserved.

P.S. Is it really true that having a mood disorder could put your license in question? I have bipolar and haven't had a manic episode in 11 years, how the heck does that make me unfit to practice?

 

[MacDonaldTriad]

This varies state to state. Most states are a balance between ADA legal action, and the need to get mentally ill doctors out of practice. Unfortunately both sides of this spectrum are valid depending on the particular case. 11 years is a long time, but best not to even go there.

 

[Merely]

Can someone please explain how the **** there is a stigma among psychiatrists about mental health???