what does a "med-check" entail?

[abcxyz0123]

I frequently see people detesting those who concentrate on doing as many 15 minute med checks as possible for the sake of $$. Just out of curiousity...what do these 15 minutes entail...and what is the purpose of a med-check? Also...do they usually last as long as 15 minutes...or can they be even shorter?

My idea of a med check is that you have to come in every couple months or so in order to get a refill or a certain psychiatric medication, and in order to do that, the doc just has to make sure you have not experienced any strange side-effects and that you are healthy. I have to do this every 2-3 months for one of my medications...but it takes less than 5 minutes. Does that fall under the description of a med check? Or is it more extensive?

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[OldPsychDoc]

I frequently see people detesting those who concentrate on doing as many 15 minute med checks as possible for the sake of $$. Just out of curiousity...what do these 15 minutes entail...and what is the purpose of a med-check? Also...do they usually last as long as 15 minutes...or can they be even shorter?

My idea of a med check is that you have to come in every couple months or so in order to get a refill or a certain psychiatric medication, and in order to do that, the doc just has to make sure you have not experienced any strange side-effects and that you are healthy. I have to do this every 2-3 months for one of my medications...but it takes less than 5 minutes. Does that fall under the description of a med check? Or is it more extensive?

Pretty much the idea. I have 20 minute appts, and usually review their meds, other meds they're on, check labs if they're on lithium or something like that, make sure the meds are having the desired effect--e.g. how's their mood, sleep, energy, voices?, etc. Chat a bit about current stressors and how they're managing... If we get into more of that than the med mgmt, I usually throw a little CBT or DBT at 'em and bill a 90805 therapy session. If there's more medical complexity I can usually justify billing a higher complexity E&M visit.

 

[abcxyz0123]

Does doing a bunch of those get boring after a while? For some reason, to me that sounds fun, mainly because I like the idea of short visits and seeing different patients more frequently....instead of staying with one patient for an hour and having things drag on. However I don't know if thats because I am only a med student and everything looks fun to me now. Is it dependent on your personality whether you would enjoy doing those for 80% of you day? Or do pretty much all psychiatrists agree that it would be hell to do that day after day (for the majority of your day), and for those that do, they only do it for the money?

 

[OldPsychDoc]

Does doing a bunch of those get boring after a while? For some reason, to me that sounds fun, mainly because I like the idea of short visits and seeing different patients more frequently....instead of staying with one patient for an hour and having things drag on. However I don't know if thats because I am only a med student and everything looks fun to me now. Is it dependent on your personality whether you would enjoy doing those for 80% of you day? Or do pretty much all psychiatrists agree that it would be hell to do that day after day (for the majority of your day), and for those that do, they only do it for the money?

I only do outpatient management half the day, covering inpatient beds in the mornings. I like the variety--every patient is different. Some are getting better, some aren't, some are "just checking in" every few months, some have a specific problem to solve, some are really frickin' sick.

Personally, *I* think it would be hell to sit with one patient for an hour week after week rehashing the same whines...

 

[TheWowEffect]

Does doing a bunch of those get boring after a while? For some reason, to me that sounds fun, mainly because I like the idea of short visits and seeing different patients more frequently....instead of staying with one patient for an hour and having things drag on. However I don't know if thats because I am only a med student and everything looks fun to me now. Is it dependent on your personality whether you would enjoy doing those for 80% of you day? Or do pretty much all psychiatrists agree that it would be hell to do that day after day (for the majority of your day), and for those that do, they only do it for the money?

Money is just a secondary issue. A med check does not usually take more than 15-20 minutes. For some patients, it takes even less than that. In a typical office/CMH setting, psychiatrists also do intakes/new evaluations. These typically take 45-60 minutes. Don't feel guilty if you like this. Many psychiatrists do it and enjoy it. Like OPD, they also often use some psychotherapy-based techniques to make the interaction more meaningful. I like the idea of also doing some inpatient or consults plus the outpatient.

 

[kugel]

You're doing a follow-up visit on a chronic medical condition - one that could, indeed, be fatal. If you think of it that way, you're unlikely to fall into the trap of simply asking closed-ended and leading questions, like,
"So, you're doing okay? Any side effects? And thoughts about hurting yourself or others? No? Good. Here's your prescription. We'll see you in 3 months."

THAT is the Med Check appt that we all joke about. It does no good, and probably leads to harm in a number of cases.

You need to be interested in your patient (or at least in the case), and ask all about the illness, the meds, the support system, life functioning... in ways that actually get answers:
"So what have you been up to? What do you do with your time?....
Tell me about an average day. What time do you usually wake up?...
What does the medicine do for you? Tell me how it helps..."

 

[OldPsychDoc]

You're doing a follow-up visit on a chronic medical condition - one that could, indeed, be fatal. If you think of it that way, you're unlikely to fall into the trap of simply asking closed-ended and leading questions, like,
"So, you're doing okay? Any side effects? And thoughts about hurting yourself or others? No? Good. Here's your prescription. We'll see you in 3 months."

THAT is the Med Check appt that we all joke about. It does no good, and probably leads to harm in a number of cases.

You need to be interested in your patient (or at least in the case), and ask all about the illness, the meds, the support system, life functioning... in ways that actually get answers:
"So what have you been up to? What do you do with your time?....
Tell me about an average day. What time do you usually wake up?...
What does the medicine do for you? Tell me how it helps..."

My #1 follow-up question: "What do you mean by 'better'"?

 

[whopper]

I like the variety--every patient is different.

Which is one big difference between residency & being a full time attending.

At my current place, I'm doing the same thing everyday, where as in residency, I had a different rotation which had a very different approach every few months.

The latter kept things new, fresh & interesting. If you didn't like what you were doing, you only had to wait a few weeks to months for a change.

But being a full time attending on a forensic unit, I'm only seeing psychosis, mania, antisocial, & substance abuse in over 90% of my patients. I've only treated an anxiety disorder about 3x so far, Depression, maybe 3x in the last year.

I was covering another unit on a doctor who was on vacation, and one of his patients was in alcohol withdrawal and almost no doctor knew how to treat it except for me because they're all land-locked into treating psychosis & mania.

To answer the question above-does it get boring? It depends. Different people like different things. Some people might like the different pace of outpatient, which has easier cases in the sense of danger to self or others, but can be more difficult in other aspects--limited time to see & educate the patient, limited exposure to see how much they improve, and if the patient blows up in anger, you don't have security and 20 staff members show up, haldol in one hand, ativan in the other.

I'm a type of person that has liked almost all aspets of psychiatry I've seen, and still want to be active in all aspects. For that reason, I'm thinking of trying to work more than 1 job in the future so I can have more variety.

 

[TheWowEffect]

You're doing a follow-up visit on a chronic medical condition - one that could, indeed, be fatal. If you think of it that way, you're unlikely to fall into the trap of simply asking closed-ended and leading questions, like,
"So, you're doing okay? Any side effects? And thoughts about hurting yourself or others? No? Good. Here's your prescription. We'll see you in 3 months."

THAT is the Med Check appt that we all joke about. It does no good, and probably leads to harm in a number of cases.

You need to be interested in your patient (or at least in the case), and ask all about the illness, the meds, the support system, life functioning... in ways that actually get answers:
"So what have you been up to? What do you do with your time?....
Tell me about an average day. What time do you usually wake up?...
What does the medicine do for you? Tell me how it helps..."

People who like to do the former are doing a huge disservice to the field, and there are many who do that. It does not take much time to do the latter. Some just don't want to do it.

 

[Anasazi23]

I have to admit, I love the med check model. In fact, I remember that there was a thread about the details of the med check a long time ago.

I think I can do a lot of good in the med-check time alloted me - depending on the case of course. Also, I'm becoming a bigger believer in the so-called "therapeutic interview." I think this concept is understudied, and I appear to be evolving my own style of this as I become more seasoned.

Not all patients are appropriate for montly or bi/tri-montly med checks of course, but not everyone has the time, desire, money, or acuity for weekly psychotherapy. For those patients for whom it is appropriate, I think a lot of good clinical work can be done in a short period of time.

 

[kugel]

I think I can do a lot of good in the med-check time alloted me - depending on the case of course. Also, I'm becoming a bigger believer in the so-called "therapeutic interview."

Every interaction is "therapeutic." Just that some interactions are good therapy, some are bad, some are terrible (e.g. my surgeon spending 12 secs at the foot of my hospital bed telling me what he's going to do today, then turning to walk away. When I called out to him and asked him - again- if he ever got/read the Doppler report on my massive DVT, and he said, "it was fine. it was fine....but don't quote me on that." and walked out. Arrrgghh!)

 

[Regnvejr]

My #1 follow-up question: "What do you mean by 'better'"?

lol, yes, or "fine" or "good." Sometimes it means they haven't killed themselves this week or didn't quite yet drop out of school.