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.