It is a fine line.

The American Psychologist recently published updated guidelines on our role in medication management:

It seems to me that the emphasis is on those with prescribing rights, and those already collaborating with prescribing providers. The rest of us are there to “provide information.” My bigger concern is whether there truly can be an effective way to communicate with our clients and other prescribing providers.

That is what gets me in trouble sometimes.

When you work with a population with multiple systemic problems in their body, polypharmacy is dangerous. I am referring not only to psychotropic medications. What I truly miss about working in an inpatient setting is that I was able to observe, monitor, and report significant changes in residents’ behaviors, level of cognitive functioning, and mood. I was able to work with other staff members and discuss these changes with the prescribing physicians. We couldn’t always “blame” the medications but this type of collaborative care had certainly saved at least a handful of residents from potentially adverse events.

In an outpatient setting, things are a little harder. Gently highlighting or discussing changes in your clients without undermining the therapeutic relationship they have with other healthcare providers can be a challenge. After all, why “should” you be the one to suggest that your client go speak with his primary care physician about the boatload of pain medications he is taking?

I prefer open and honest communication. I do not mind spending the extra time to obtain a release of information to speak with other providers if there is a need. I don’t mind being yelled at or told to “mind your own business.” Thankfully, it has only happened once in the past 5 years.

In the end, we all want the best for our clients without driving ourselves or anyone else crazy. It just isn’t easy sometimes.


About C

If you consider volunteering at a luncheon for older adults as my first exposure to the field, I have been in geropsychology for at least twenty years. As family, friend, volunteer, trainee, and professional, I have found myself in adult day care centers, senior centers, senior living facilities, nursing homes, medical and psychiatric wards, hospice, and personal homes of older adults. Wherever I go, be it an orphanage, a museum, a prison, an airport, or a random corner in the neighborhood, issues related to aging and mental health often come to mind. I used to think that I could make a difference only if I became a top-notch researcher, educator, or clinician. As I continue to follow this meandering path, it dawns on me that as a nobody in the field, I can still add my light to the sum of light by sharing what I know. Over the years, I have "converted" a few very dedicated individuals to focus on aging-related work within their respective disciplines and encouraged a handful more to stay in this field despite its winding course. I believe by bringing aging and mental health issues to the foreground, we will amass a stronger force to promote advocacy, research, and quality care.
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2 Responses to Crazy

  1. When I worked in the psychiatric hospital, we used to note behavior changes in the patients every morning in a brief meeting with the psychiatrist, aides, and other staff members. The psychiatrist was able to adjust medications based on the information, and the aides and other team members saw immediately how important their observations were and simultaneously learned which observations were important and why. It’s a model that could be easily translated into the nursing home environment and an outpatient setting, if supported by the administration.

  2. C says:

    Dr. El,
    I’ve seen a similar model in one LTC setting as well, but it is also psych-based. It’s much harder to accomplish this level of collaboration and continuum of care in non-psych outpatient settings where providers are not from the same system… It’d be really nice to see it happen. Even within the same system, patients still get bounced from one place to the next sometimes, being asked the same questions every time. I thought the development of electronic medical records was going to help, but it actually depends on the providers. The same is true about interdisciplinary teams. When done well, it is efficient, effective, and empowering to patients, family, and staff.

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