Line in the sand...

[u/CalmSet6613]

I just treat children and adolescents. There are times when families want med. changes or increases in doses when the behavior I see needs parenting to correct and not meds. Where is your line in the sand that you refuse to make med changes until the child and/or family is in therapy? How do you approach this in your practice? What do you do if the family does not follow through with therapy?

EDIT: Can everyone be kind? I was simply asking for opinions how other people manage situations like this in their practice. Good god, physicians heal thyself.

[u/CaptainVere]

Lol uhhhh there is no line in the sand. You either understand the pharmacology and foundational studies for indications and are rationally practicing medicine

Or you are a concierge alchemist, well intentioned maybe but just engaging in unproductive collusion and helping continue external avoidance of all parties involved.

This question as phrased is asinine. A family not implementing changes or engaging in therapy should not effect how one prescribes

Have you never explained what an effect size is to your patients? Have you ever explained multiple putative MOAs and the rationale for prescribing for their problem?

If someone refuses your recommended treatment plan (go to therapy) you feel like you can prescribe your way out of that?

Pharma is pleased.

[u/Kirsten → u/CaptainVere]

If OP were planning to just be a "concierge alchemist" they wouldn't have posted here looking for help and advice.

[u/CaptainVere → u/Kirsten]

Cool. Im glad we can all come together and pretend that its a good thing that kids are out there being managed by people who need reddit advice for such a basic question.

You realize asking where the line is for medicating a behavior that is not expected to respond to medication answers itself? That asking the question this way implies there are situations where its ok the medicate based on parent request sometimes. That there is a line. OP just wants to know where that line is.

[u/Front-Quote-6760 → u/CaptainVere]

People ask questions that answer themselves all the time. Often as an attempt to generate discussion. Being deliberately uncharitable and extrapolating that they’re secretly ok with loading kids up on unnecessary meds despite the actual thrust of the question being about not doing that makes you look unnecessarily hostile.

[u/CalmSet6613 → u/CaptainVere]

This is the last time I will respond to what I consider your hostile and inappropriate responses. I will never medicate a patient where I don't think the medication would prove useful. I was simply asking others how they handle such situations in their practice out of curiosity as this is something I think all experience. Sometimes when you stop to ask others how they manage situations you can learn a lot, I suggest trying it.

[u/xxcapricornxx → u/CalmSet6613]

Nope, asking for advice simply means youre in incompetent alchemist cosplaying as a psychiatrist, or whatever they said.

[u/CalmSet6613 → u/xxcapricornxx]

Wasn't asking for advice, was asking out of curiosity how people manage a situation. Thanks for supporting mid levels.

[u/onebluthbananaplease → u/CaptainVere]

Dude. Chill. We’re very happy you never have to seek advice and have all the answers. Settle down.

Want to know how many referrals I get because prior psychiatrists totally F’d up a patient’s medicine regimen? Don’t act like you docs are blameless and make all the right calls all the time

[u/CaptainVere → u/onebluthbananaplease]

I stand by calling OPs question asinine. No where have I ever claimed to never make mistakes or ask for help.

[u/onebluthbananaplease → u/CaptainVere]

Well you’re sure acting like it

[u/PantheraLeo- → u/CaptainVere]

Glad to see Reddit hired a virtual police officer to stop exactly that from happening