Can any doctors answer this question?

[BabyClubYEEAAH]

There is a movement of deprescribing amongst prescribers due to over medicating of patients.

Would you deprescribe a patients medication without consulting or reviewing them first?

For example, a patient with bipolar disorder, having their medication stopped without review.

Would you consider this medically negligent?

If yes could you answer why? And also if no?

Bump?

DH takes heart meds...a few yrs back he was 2 months late for his review and a GP not the one he normally sees said they could refuse his repeat because he'd had no review.

He's just had a review - 3 months late - but was told they're still working thru the backlog from last yr.

I appreciate that doesn't answer your question, but the first GP was a twat and when DH ended up in A&E then needing surgery, lets just say he wasn't v popular with DH normal GP...

Would you consider this medically negligent?

There's nowhere near enough information here to base an opinion on. What medication was the patient on? Who was the doctor who made the decision (GP, A&E consultant, psychiatry trainee, consultant psychiatrist)? What was the setting (community, out-patients, hospital ward)? Had any tests been done that showed dangerous side-effects? What do you mean by "stopped"?

Not enough info on here, but there could be a few reasons why something might be stopped. If they are on lithium but not attending for monitoring, inappropriately on SSRI causing mania, new pregnancy and on harmful meds etc. Even then I would imagine there would be at least an attempt to contact the patient. In all of these examples it would be negligent to continue the medication.
If you are referring to simple deprescribing to reduce side effects etc that would usually be done at a medication review. If you are unhappy with your / your loved one's care then best to ask the medical professional involved rather than mumsnet.

Patient on lithium happily, no side effects. Stopped to have baby but then refused to be allowed to go back on them. Patient in a bad way now mentally. Consultant psychiatrist had not made any contact with patient at all and has sent no follow up, no explanation just a “no”.

So it was stopped due to the patient crying pregnant.
Patient needs to make an appointment to say they need to go back on it.

Being not crying

How do you know there is a movement of deprecribing? I wish there was as so many people are on ridiculous amounts these days but don't appear to be any better because of it.

Because I work in mental health.

Patient has been trying desperately to access help for months.

There's no movement of deprescribing. It's a movement of stopping overmedication. Sadly this has meant that some find it more difficult to access medication.

The patient needs to arrange an appointment.

How exactly does the patient arrange an appointment?

Call the psychiatrists secretary and ask to make an appointment.

If you are discharged from mental health services you need to speak with your GP.

There is no secretary to contact. The GP’s won’t allow any appointments as it’s not deemed urgent. When a GP was eventually spoken to there was no record of anything on the patients file so they said they couldn’t help and ended the call. Primary care can’t help as patients needs are too severe. Adult mental health keep rejecting the patient because the psychiatrist has said it’s not necessary for them to be involved. No follow up, no alternative medication has been offered. Just discharged from all services with nowhere to turn.

I beg to differ. DM (elderly, frail, so not really of an age for concern about misuse of drugs), has had some of her pain medication randomly reduced - not a particular problem in itself, she's learnt to manage, but in her last repeat prescription, she only had one of her inhalers instead of two. On enquiring about it, I was told 'she's due for a review in December so the medicines team decided to reduce it to one in the meantime'.
She has emphysema.
When I pointed this out, the reply was 'oh I see, yes, I'll ask them to put it back up to two'. The best bit about it was that neither I or DM were told that this had happened. If we'd known, it could have avoided the extra phone calls and trips to the pharmacy.

Bipolar lithium in a bad way and psychiatrist won't see. Any mental health appts in pregnancy?? BAD can get worse in post partum period. I have a friend who had to be sectioned and was put into a mother and baby unit after delivery. She really struggled with the lack of sleep and exhaustion. She was watched like a hawk. Odd that this person has just been left.

Mental health midwife should be able to access support if they’re still in contact.

If you have involvement with this patient on a professional level then you really shouldn't be posting on here. You should be talking to your senior.
If this is a personal relationship, then the patient can ask their GP to email the psychiatrist directly for medication advice. If someone has bipolar and is in poor mental health then it should be deemed as urgent by the GP practice. Even if they don't have any info about them on file (sounds odd) as long as the psychiatrist's name is known that should work. Also, if she gave birth less than a year ago she could get help from the perinatal mental health team.

'They've' probably been off the lithium for too long, it's been stopped so can't just be reissued.

Next step would be to book in with the GP for regards struggling with MH/BiPolar, not the medications. That can come up in the consultation - see what's available in terms of referral back into MH services or treatment from GP, can be social prescribing or prescription. Not all GPs will be comfortable prescribing certain medications and will defer to a specialist in these instances.

No baby was born over a year ago. Plan was drawn up by the Perinatal team to restart meds when breastfeeding had ended. However, perinatal team now nurse led so transferred to adult mental health who has rejected the case. Perinatal won’t take back on as a patient.

There's no way this was written by a HCP.

What the fuck do you know?

Have you tried contacting the consultant psychiatrist via the secretary? There will be numbers on the letters

There’s been no letters!

What support has your GP offered when you've told them you're struggling with your MH?

There will be as the GP would have been informed of the care decided and treatment. If you know the name of the consultant then try the switchboard and ask to be put through to the secretary