u/KaiserWC

We’ve all been there. A patient wants a medication that, while it might help them, has a side-effect burden that keeps you up at night. The patient has capacity to make the decision. Maybe a patient who’s failed everything for crippling anxiety doesn’t want to stop benzos after a fall where she broke her hip. A metabolic pt with schizophrenia and a BMI of 70 will only take olanzapine. A patient with severe TD refusing VMATIs refuses to reduce their haldol dose. These are just some examples.

where do you draw the line between “the patient can make this decision,” vs. “this is straight up malpractice?”

Please note: I am asking about the risky intervention specifically. When answering, please do not recommend continuing to talk the patient into a less risky alternative. Assume this has been tried and failed.

I am in an outpatient community mental health center and we have had several patients with schizophrenia kicked off their Medicaid in the last few months. Admin is telling us that if our patients aren’t organized enough to re-enroll themselves in Medicaid or make the appropriate phone calls, the psychiatrist will need to do it for them during their appointments. Is this something you guys are seeing?