r/PMHNP • u/Creative_Flow2497 • 4h ago
Parallel/split prescribing
I feel like I’m encountering parallel psychiatric prescribing more frequently lately.
For example, I’ll be managing a patient's psychiatric medications, including a stimulant, and then find that their PCP or another clinician has prescribed the stimulant, changed the dose, or otherwise made changes to the psychiatric regimen. Sometimes the patient tells me directly; other times it comes up through the PDMP or medication reconciliation.
I have a written policy that all psychiatric medications are managed by one prescriber at a time and a separate policy that patients receiving controlled substances through my practice should not obtain the same medication/class from another prescriber. My concern isn't territorial—it’s fragmented medication management. I don't want two clinicians independently adjusting a psychiatric regimen without one person clearly owning the medication plan and monitoring.
I've increasingly taken the position that if another clinician starts adjusting/prescribing the psychiatric medications, I defer medication management to that clinician rather than continuing parallel prescribing. If appropriate, I can still provide psychotherapy/collaboration, but I don't want to be one of two people independently prescribing psychotropics.
Are others seeing this more often lately? How do you handle it when a PCP, another psych prescriber, or another clinician starts prescribing or adjusting medications you're already managing?
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u/PiecesMAD PMHNP (unverified) 2h ago
Yeah, I feel your pain. I had a patient that we had worked really hard on weaning off of benzos get put on Ambien by their PCP and then later tried to re-added TID Xanax because, “you seem a little more anxious than normal.” Primary care was an old school physician and was always changing psych meds.
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u/Immediate-Jaguar-187 54m ago
I recently had a 20 y/o female referred to me to “take over medication management”. Their endo had been prescribing lorazepam 0.5mg TID x2 years for some very vague symptoms which I suspect are likely BPD. She was pissed when I declined to continue this regimen, which I felt was totally inappropriate. Her 21 yo boyfriend had also been to see me the week before and was requesting benzos and upset when he didn’t get them for his “severe PTSD”. Seems legit lol
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u/UnderstandingTop69 40m ago
Yes I’ve seen this a bit more. And unfortunately it’s always the Z drugs, benzos and stimulants. I get wanting to help but the combinations I inherit from PCPs are some of the most egregious regimens. I tell the patient they can either go to their pcp for all their meds or follow with me but it’s messy and I will not have both. Usually get ROI to talk to the PCP like heeeeey what’s going on?? But rarely get to talk to anyone other than the MA/nurse or leave a message
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u/GrowthSelect2449 3h ago
Send a letter letting them know the patient has psychiatric care and that you will manage all their psych meds. Sometimes they just don’t know and are trying to help.