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?

This happened to my dad, he has COPD and was due a review which continuously got pushed back due to Covid, in the meantime the GP continued to prescribe two regular inhalers. Until the medicines team decided he only needed one. So one day he collected his prescription to find they had decided he was only allowed one until he had a review, which he was sat on a waiting list for. So in the meantime he was suffering and struggling.
He had hell on trying to get a review appointment and every time he requested the 2nd inhaler to the GP it got rejected by the medicines team.
He ended up getting his 2nd inhalers from a bloke he knew down the pub who got them prescribed but never used them... FFS.

Eventually he told me what was happening, I called the medicine team whose words to me were 'We can't prescribe the 2nd inhaler again until he has his asthma review' to which I went ballistic as 1. he doesn't have asthma, he has COPD and has had for years and 2. This had been going on for 8 months and still no review.

He has now been reviewed and issued with 3 inhalers, so he actually needed more not less!

I don’t even know the name of this person. I’ve been told nothing.

Surely there must have been some letters or documentation in the past when she was on the medication? Can these not be followed up?

I'm confused? You don't know the name of the adult psychiatrist but yet you say it was the psychiatrist who advised that the adult mental health team didn't need involvement?

Yes! They didn’t never said the name of the psychiatrist and there is no correspondence to look at. And when I eventually got though to the gp they said there was nothing on the file about it.

The OP is the patient. They've posted about this several times before.

Had my antidepressants on repeat removed because I hadn't had a review. Had many items randomly removed unbeknownst to me so yes they do!

@VeronicaFranklin, it beggars belief, doesn't it?
Who ARE these people who think they know better than, in my DM's case, a respiratory specialist?

This sounds utterly crazy. Its like a patient with diabetes having their meds stopped with no reason given. The patient presumably has a long history of being treated for BPD and medicated? I think PALS at the hospital. Do MH hospitals have PALS? Then the Trust board or Trust director or someone who employs the psychiatrist.

Sounds incredibly dangerous and not understandable.

In general no, it needs a discussion.
Sometimes if we've tried to have the discussion and the patient won't engage I'll issue one last script, take it off the repeat and send a text saying come to discuss if you need more.

But that's for meds of low value. For lithium? unlikely. Though might be driven to it if they refuse to come for monitoring to the point that it's unsafe.

For what it’s worth I’m not against deprescribing at all!

But I do think the patient involved should at the very least be reviewed to assess their current needs.
Every mental health nurse I have spoken to has advised to complain formally in writing and have agreed that I’ve been treated appallingly and really failed by the entire nhs service.
I just think it’s really dangerous. I am so so unwell.

If you are feeling very unwell could you ring 111? Get an out of hours apt? Or present at A&E? This sounds crazy but depending on how you feel mental health symptoms can be a medical emergency too. Sorry you are feeling so unwell.

No what would be dangerous would be for a GP who might not know you, to prescribe a medication like lithium to you which you haven't taken for over a year without seeing you, or having any blood results (thyroid and kidney function amongst other things). That really would be dangerous.

They've not deprescribed you without consultation, you said it was planned with you to stop it when you became pregnant. Now you're not pregnant you would need to have a review regards if it appropriate/right medication/safe/right dose before restarting.

Book in with the GP for help with your mental health. That consultation needs to happen to help you get the right treatment and if that includes lithium then it can be prescribed.

If you are so unwell and the GP won't see you and adult mental health won't accept you I would suggest you contact the crisis team, you can self refer. Google for details in your local area. They should be able to assist you and perhaps get the adult mental health team to review you urgently

Thats true you can often self refer back in, search for IAPT + name of your town/city and might through up the correct page to do so.

I have had all the blood tests, I was ready to go back on it was all written up in a plan by the perinatal teams consultant. The new psychiatrist has just over ruled and it said no with no explanation.

Crisis team won’t help me be sure I’m not actively planning to kill myself. Yet.

What I’m basically being told by everyone is I need to attempt suicide first before anyone will help me. Which I’m actively trying to avoid but no one is interested.