Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

When primary care handles the consequences of psychiatric medication prescribing

Hans Duvefelt, MD
Physician
January 13, 2020
138 Shares
Share
Tweet
Share

If my hypertensive patient develops orthostatism and falls and breaks her hip, I fully expect the orthopedic surgeon on call to treat her. I may kick myself that this happened, but I’m not qualified to treat a broken hip.

If my anticoagulated patient hits his head and suffers a subdural hematoma, I expect the local neurosurgeon to graciously treat him even though it was my decision and not his to start the patient on his blood thinner. After all, brain surgery is tricky stuff.

Why is it then that primary care docs, sometimes myself included, feel a little annoyed when we have to deal with the consequences of psychiatric medication prescribing?

My psychiatry colleagues diligently order the blood work that is more or less required when prescribing atypical antipsychotics, for example. But when the results are abnormal, I get a fax with a scribble indicating that the PCP needs to handle this.

We need to just deal with that and appreciate that there has been communication between treating providers. Because that doesn’t always happen. Particularly with medication prescribing, we don’t always get a notification from our psychiatry colleagues when a patient is started on something new because their records are so much more secret than ours.

The other day I sat in my monthly conference with staff from the behavioral health home that I serve as the medical director for. I consult on clinical and policy matters.

I heard of a couple of examples like the one in the headline and thought that we need to have a clinical collaboration contract in place between providers who see these patients.

This would require notification when medications are started or changed, and an expressed understanding that the participating clinician who is best qualified to treat a complication of either a psychiatric or somatic medication should do so.

If a prescribing provider notices that their prescription has a side effect, but the medicine is clearly the best choice for the patient, I can’t just expect them to stop what may be a major therapeutic breakthrough for the patient.

Here are some ideas for what a clinical collaboration contract might include:

I will tell my colleagues if I start, stop or change any medication.

I will share lab work I have done in order to avoid duplication.

I will update my colleagues on major changes in the patient’s health or circumstances.

I will collaborate with my colleagues for the benefit of the patient even if it’s inconvenient.

I will not criticize my colleagues in front of my patient but raise my concerns provider-to-provider in a professional and open-minded manner.

Maybe this is too obvious and self-evident to formalize, but judging from the stories I heard the other day, it probably isn’t.

Hans Duvefelt, also known as “A Country Doctor,” is a family physician who blogs at A Country Doctor Writes:.

Image credit: Shutterstock.com

Prev

After child sexual abuse, being "physically intact" doesn't tell the whole story

January 13, 2020 Kevin 1
…
Next

This nurse was hiding the truth behind social media

January 14, 2020 Kevin 6
…

Tagged as: Psychiatry

Post navigation

< Previous Post
After child sexual abuse, being "physically intact" doesn't tell the whole story
Next Post >
This nurse was hiding the truth behind social media

More by Hans Duvefelt, MD

  • The art of asking where it hurts

    Hans Duvefelt, MD
  • Thinking like a plumber when adjusting medications

    Hans Duvefelt, MD
  • The American food conspiracy

    Hans Duvefelt, MD

Related Posts

  • Primary Care First: CMS develops a value-based primary care program for independent practices

    Robert Colton, MD
  • Primary care makes a difference for patients and the nation

    Glen R. Stream, MD
  • The many benefits of strengthening the primary care workforce

    Nicole Liner-Jigamian, MSW
  • Primary care faces a very difficult winter

    Ken Terry
  • The biggest health care fix: a relentless focus on primary care

    Suneel Dhand, MD
  • The hidden work of primary care

    Michelle Nall, MPH, ANP-BC

More in Physician

  • Physicians have no autonomy. Here’s how to change that.

    Diane W. Shannon, MD, MPH
  • The erosion of patient care

    Laura de la Torre, MD
  • Navigating adulthood in the digital age

    Eleanor Menzin, MD
  • The power of business knowledge for medical professionals

    Curtis G. Graham, MD
  • Using the language of art to create work-life balance

    Sarah Samaan, MD
  • Lively communication in the service industry

    Deepak Gupta, MD
  • Most Popular

  • Past Week

    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • I’m tired of being a distracted doctor

      Shiv Rao, MD | Tech
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Transforming primary care for physician well-being [PODCAST]

      The Podcast by KevinMD | Podcast
    • Family support is pivotal in the treatment of schizophrenia

      Frank Chen, MD | Conditions
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
  • Recent Posts

    • Transforming primary care for physician well-being [PODCAST]

      The Podcast by KevinMD | Podcast
    • COVID-19 unleashed an ongoing crisis of delirium in hospitals

      Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD | Conditions
    • Doctors and disability insurance: Protecting your income

      Amarish Dave, DO | Finance
    • Emergency care nightmare: the urgent need for experienced nurses

      Rachel Basham, RN, CCRN | Conditions
    • Physicians have no autonomy. Here’s how to change that.

      Diane W. Shannon, MD, MPH | Physician
    • Understanding intersex health care [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Report: Persistence of Gender Inequalities in Cancer Care, and a Call to Action
  • Cancer Risk in NAFLD Higher With Early Disease Onset
  • FDA Displeased With Companies Purposely Adding Sesame to More Foods
  • COVID Vax Appointment Cancelled? New Shot Rollout Faces Challenges
  • Medical Residents Receive 100+ Job Offer Contacts, Survey Shows

Meeting Coverage

  • New Schizophrenia Treatments Are Coming: Don't Panic
  • Loneliness Needs to Be Treated Like Any Other Health Condition, Researcher Suggests
  • Stopping Medical Misinformation Requires Early Detection
  • AI Has an Image Problem in Healthcare, Expert Says
  • Want Better Health Outcomes? Check Out What Other Countries Do
  • Most Popular

  • Past Week

    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • I’m tired of being a distracted doctor

      Shiv Rao, MD | Tech
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Transforming primary care for physician well-being [PODCAST]

      The Podcast by KevinMD | Podcast
    • Family support is pivotal in the treatment of schizophrenia

      Frank Chen, MD | Conditions
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
  • Recent Posts

    • Transforming primary care for physician well-being [PODCAST]

      The Podcast by KevinMD | Podcast
    • COVID-19 unleashed an ongoing crisis of delirium in hospitals

      Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD | Conditions
    • Doctors and disability insurance: Protecting your income

      Amarish Dave, DO | Finance
    • Emergency care nightmare: the urgent need for experienced nurses

      Rachel Basham, RN, CCRN | Conditions
    • Physicians have no autonomy. Here’s how to change that.

      Diane W. Shannon, MD, MPH | Physician
    • Understanding intersex health care [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

When primary care handles the consequences of psychiatric medication prescribing
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...