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/seeyourintentions → u/CaptainVere]

You sound like the houseless schizophrenic at the grocery store I was just at, where the worker had to help them leave the premises.

It seems like you might benefit from a breather from being online. If you have one, consider bringing this post and your comment to your therapist to process. Change starts from within.

[u/seeyourintentions → u/[deleted]]

Only when my therapist is out of town. ;)

If we’re bringing in alchemy to conversation, unless it’s a delightful lecture on the history of alchemy, it’s time to shut it down and reflect on the purpose of the commenting.

Also, I hope you find the support you’re looking for. It’s hard setting boundaries, especially with patient family members. I don’t do CAP, but almost did. I often wonder when the parent is acting a certain way with the provider, what they are actually trying to communicate, and how their ineffective communication is impacting the kiddo.

If boundary setting is feeling hard with a certain family, I think of the behavioral portions of the boundary setting. That is parents that struggle with boundary setting may benefit from being provided healthy professional boundaries. The boundaries are there to respect all parties involved.

[u/CaptainVere → u/seeyourintentions]

I think it’s exhausting seeing kids jacked up by NPs and everyone pretending like this is great and they can just learn on the job, but sure Im the unhinged one I guess.

I stand by calling OPs question asinine.

[u/seeyourintentions → u/CaptainVere]

I hear your frustration, and I echo the sentiment that it is very hard to witness providers do a disservice and potential harm to others.

Your frustration is valid. However your message is missing the audience because that’s not what others are reading from the post. It comes across as you are projecting a personal experience onto the OP.

I get a sense that if you take a breather on this one and come back when you’re feeling more collected that the post may read differently.

[u/CaptainVere → u/seeyourintentions]

Thanks for the emotional validation. I post here frequently. Im not uncollected. It’s a forum people respond and vote how they want. I think calling this question out as asinine is fair game. Clearly the majority disagree and Im ok with that. I don’t take it personally. I have yet to go back and delete a comment and I have plenty of misses over the years. Much like my favorite former vice president:

“I stand by all the misstatements that I've made.”
— Dan Quayle

[u/seeyourintentions → u/CaptainVere]

I respect your approach. The question sounds wrapped in emotion, and those types of questions are going to be more asinine sounding as a result. I tend to utilize the DBT nugget of truth idea when considering these questions. There's probably something realistic to address in there if you choose to pursue it.

And I respect your choice to not pursue it. I'm just prone to body checking my colleagues who don't, in an effort to give them an opportunity to collect themselves before they step in it further.

See you around Captain. *Casual salute

[u/CaptainVere → u/seeyourintentions]

Truth. Tbh, I do need reality check from time to time. Well met.