I've decided to put together a list of details about my professional philosophy & practices for future patients to review ahead of our initial appointment to help ensure that you are choosing the right provider to meet your needs before you even have to set foot in the office.
I am licensed to work with individuals over the age of 18
If you have seen someone else for medication management in the past (or are coming from a hospital/program), I request and highly recommend providing a copy of your records before our first meeting. This will allow me to review past history and trials during our intake appointment, when we have more time to do so than in a follow-up appointment.
Explanation of Urine Testing Philosophy In an effort to ensure the highest quality of care for my patients, I routinely obtain a urine analysis for a patient’s initial visit with myself as a new care provider. Doing so universally versus case-by-case, is my effort to minimize personal bias when assessing for substance issues. If I ask everyone to submit a sample, I remove the issue of judgment/assumption, while also enhancing my ability to detect any possible issues as early as possible. You may refuse to provide a urine sample, but know that it will directly impact my ability to prescribe certain medications, including benzodiazepines and stimulants.
I feel strongly about the issue of Benzodiazepine Dependence. In line with recent research, I do not believe that consistent or long-term use of these medications (even at low-doses) is advisable for psychiatric purposes. If someone comes to me on a consistent and/or high dose of such a medication (ex: Xanax, Ativan, Klonopin), they can expect that I will work with them to plan out a slow and comfortable taper to discontinue use. Most of my patients that still utilize this medication, are given a small supply (5-10 pills/mth) for break-through panic episodes or very specific circumstances, i.e. travel and sign a collaborative agreement, which requires they do not use other controlled/illicit substances.
I do treat adults with ADHD. If someone expects to be treated for this condition, they should be prepared to have documentation confirming prior diagnosis of ADHD to the office before the intake appointment - this may be past psychiatric appointments or school documents. If someone is questioning whether they may have ADHD, I encourage them to mention this to the intake scheduler so that you can be directed to an appropriate evaluation resource.
Regarding stimulant medications- they can be a very helpful class of medications, however they are also very controlled. In the same class as opiates, like Oxycodone. I am very strict about my use of such a highly regulated medication and therefore, will not prescribe it to anyone abusing any kind of illegal substance.
Regarding "Medical Marijuana" - My ability to prescribe is regulated by the DEA - an organization, which does not federally acknowledge the medical use of cannabis. To my mind, there is currently not enough peer-reviewed, rigorous research available that clearly supports the use of cannabis as a psychoactive agent with too many possible negative consequences to condone its use at this time. I will not deny care to a patient with a 'Medical Marijuana" card, however, it will affect what medications I feel comfortable prescribing to them.
For anyone who is in recovery with the assistance of specific medications, namely Suboxone or Methadone - I do not believe it is safe to also prescribe benzodiazepine medication, ie. Xanax, Ativan, Klonopin, etc. This may also apply to other sedating hypnotic and pain management medications. Many opioid-related deaths (over 30%) show the presence of this medication in the person's system and it is specifically contraindicated in psychiatric best practice. I do not feel that the use of such addictive medication is in the best interest of the patient or their recovery process.
I have a strong interest in integrated psychiatry and functional medicine. I try to incorporate this into my practice as clinical evidence allows. I recognize that diet, exercise and sometimes supplementation can make a big difference in someone's mental wellness. So, don't be surprised if I 'prescribe' an exercise regimen or particular diet as part of medication management. (With primary care approval - of course!)
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