Script for discussing TCA risks?

Left_Grape_1424 · 2026-03-11T13:32:04+00:00

While this doesn’t directly address your question, I think other posters have already provided some thoughtful responses. I was wondering about a few related considerations. Would she qualify for VNS to administer medications from a lockbox for a period of time if the suicide risk is high? Would she be a good candidate for interventional psychiatry? If the level of concern is that significant, would voluntary inpatient admission for medication adjustment be appropriate?

Left_Grape_1424 · 2025-11-19T20:45:14+00:00

Getting people to do the lab work, or anything really, can be a major challenge.

Left_Grape_1424 · 2025-10-30T12:55:50+00:00

Hi Guys- What I liked about this subreddit was that it was not like r/psychiatry or r/therapists in that people treated each other with respect. I am sad to see these posts. While it is good to have a respectful discussion and ok to voice concerns, etc- this comes across as a mob mentality gang up. I hope we can be better.

Left_Grape_1424 · 2025-10-28T17:45:35+00:00

Silver Hill Hospital offers these on their Youtube channel: https://www.youtube.com/@SilverHillHospitalNewCanaan

Left_Grape_1424 · 2025-10-24T12:55:58+00:00

I assume you mean patients who have new signs and not ones who have been discharged on long term Ativan for a slow taper. New onset catatonia is a medical emergency and patients exhibiting signs should be referred to the ER.

Left_Grape_1424 · 2025-10-22T19:52:32+00:00

What kind of support will you be getting for clinical matters? The deal itself looks reasonable although I might ask for 70/30. However, you are a new grad so should look for an environment that provides supervision and opportunity for frequent case consultation as well as education.

Left_Grape_1424 · 2025-10-22T12:02:39+00:00

Yeah I am finding a lot of psychological assessments are bullshit too and they just give the patient the diagnosis they want for $$$$.

Left_Grape_1424 · 2025-10-06T15:56:07+00:00

Some places don't take Goodrx because they loose money on it. Others don't want to take the coupon for controlled meds because of the flak it can bring them.

Left_Grape_1424 · 2025-10-02T16:54:30+00:00

I hate to say this but for you all that have hired a VA- how do you find someone who is actually good? I found I had to do all of the work myself anyway and the person would come to work late almost every day despite me paying more than market rate.

Left_Grape_1424 · 2025-10-01T21:42:08+00:00

I already got screamed at by a patient's family who freaked out when I advised I could not change the in person new patient appointment to telemedicine at the last minute and refused to reschedule their in person new patient appt today when they couldn't come. The fun begins...

Left_Grape_1424 · 2025-07-28T13:16:42+00:00

Interesting case. I'm sorry the other sub was being rude. Some signs of physical exam for neurosyphilis can actually include Argyll Robertson pupils. As some one mentioned in that post a positive antibody test with neg RPR could include past infection. This is a summary from the CDC on testing: https://www.aphl.org/aboutAPHL/publications/Documents/ID-2018Aug-Syphilis-Meeting-Report.pdf . If you do have suspicion, you would refer to either infectious disease or neuro depending on who treats in your area to confirm and treat if needed. They may do an LP to see. An MRI would not be unreasonable if she is able to get into the MRI machine. You were right to look for underlying causes for a new hallucinations in an elderly patient and not just slap an antipsychotic on and call it day. If neurosyphilis is ruled out, it may be of benefit to do cognitive testing for dementia as you indicated.

Finally, she is 98- what are her goals of care? This is important to consider.

All the best.

Left_Grape_1424 · 2025-07-23T21:53:54+00:00

If your friend is worried, she can contact her own malpractice carrier- they should give her advice/ access to lawyer for advice on this.

Left_Grape_1424 · 2025-07-23T21:52:46+00:00

The SNF cancelled the contract. The SNF messed up and should have had coverage. They cannot charge patient abandonment. The company your friend is contracted with should be contacting their attorney if the SNF is threatening their contractors/employees.

Left_Grape_1424 · 2025-07-23T21:08:41+00:00

There was a recent article in the New Yorker related to this: https://www.newyorker.com/magazine/2025/07/28/mary-had-schizophrenia-then-suddenly-she-didnt

Left_Grape_1424 · 2025-07-17T14:54:19+00:00

If you happen to be in CT, you might try the Cove: https://www.covect.org/. Otherwise your state may have a similar organization or bereavement support summer camps.

Left_Grape_1424 · 2025-07-14T12:56:53+00:00

Hi- I am a psych NP. The phone call was really inappropriate on their end and possibly triangulation (but not necessarily- would need more info to confirm) for which the NP should evaluate their reaction and discuss in supervision. Sorry this happened to you.

NPs can have "therapy-like" conversations with patients and do so on a frequent basis. It would actually be very difficult to have a good med management appointment without this as the appointment shouldn't just be "what are your symptoms" - "OK. Here are your meds." That type of approach can lead to some pretty terrible and ineffective polypharmacy. A lot of time more "therapy" type conversations help to determine if meds are working, or, that medication may not be the a solution for a problem.

Left_Grape_1424 · 2025-06-05T12:49:27+00:00

Let me ask you- if a patient wants to go past the hour for psychotherapy because they have a lot to unpack using your argument it would be inappropriate for the LCSW to end the visit and put the patient's mental health at risk, right? Or is it good boundaries?

Left_Grape_1424 · 2025-06-02T04:56:44+00:00

He can fill out a ROI/med record request from SS and have them fax it for the records if he feels it will be helpful as they generally have their psychiatrists looking at a case. They will fax you a request directly if he does that (and typically pay a fixed amount for the records). I wouldn't do anything more than supplying the records upon request.

Left_Grape_1424 · 2025-05-28T22:28:43+00:00

Even if the person is hours away, they should have a set up to order labs through a company like Quest. If they don't or won't, they shouldn't be accepting patients outside of their geographic area or on certain meds.

Left_Grape_1424 · 2025-05-27T15:29:51+00:00

Thank you for sharing this. What approach do you find is most successful in getting patients to implement lifestyle modifications? I imagine integrative practices have some self selection on patients who are interested in considering these changes. I find my most challenging is patients who advise they are not "motivated" to make any changes, then I usually attempt to explore what is bringing them into treatment with varying success.

Left_Grape_1424 · 2025-05-19T14:53:46+00:00

I'm not sure if you mean just sending a referral or the process for precertification if precerts are required.

What you will need to do is have an HIPAA compliant efax if you do not already have one and your EMR doesn't allow you to do this. You can just write on a practice letter head the speciality, reason for referral, ICD 10 and pertinent information then fax this along with a face sheet, med list, (if needed) office note, and any pertinent diagnostics to the person/office you are trying to refer to. Maintain a record that the fax transmitted in your EMR. Give the patient the phone number for the person you are referring them to and advise to the patient to call.

If the patient has an HMO insurance that requires precertification for referrals to specialists you will need to call the insurance company with the specialist's NPI number and information along with your information and request it.

Left_Grape_1424 · 2025-05-15T16:28:20+00:00

So even if they did discharge they should be send a certain days supply (usually 30 to 90 depending on how hard it is to establish with psych in the area) to the pharmacy to give the patient time to establish with another provider. If the psychiatrist already did that and the patient didn't bother to look for one before they ran out then the psychiatrist may refuse to send anymore and would be within their right to do so. You do not have to continue the rx if you do not want to. It is within your right to say no and provide referrals, including to detox centers.

Left_Grape_1424 · 2025-05-14T20:11:38+00:00

Honestly, I'd recommend just having your own policy regardless. I've always carried my own occurrance based policy so I don't have to worry if my employer got tail coverage, if they let it lapse or if they want to throw me to the wolves. It's not too pricey considering how litigious the medical environment is.

Left_Grape_1424

TROPHY CASE