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How do you handle requests for medication refills from patients who were formally terminated from care but report difficulty accessing a new psychiatrist?

What boundaries do you typically set once the therapeutic relationship has ended? Does your approach change if the medication carries a risk of dangerous withdrawal (e.g., benzodiazepines)?
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After terminating care with a patient, how much medication do you prescribe for them?

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4 Answers
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Psychiatry · Kirk Kerkorian School of Medicine at UNLV
Answered on

It is essential when terminating a patient that you provide at least three formal referral names with a 30-day notice. One of these should be an agency that cannot refuse patients. This could be a county or state mental health clinic. If the referrals you provide refuse the patient, then you are obl...

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Psychiatry · McLean Hospital/Harvard Medical School
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This is a common situation that causes a great deal of angst and confusion among all medical specialties, not just Psychiatry.

First, the context: the question posits an appropriate formal discharge. Next, it is important to note that while this discussion addresses issues with legal implications, i...

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Psychiatry · Christiana Psychiatric Services
Answered on

In the unusual event of terminating a relationship with a patient, we allow a 60-day period for them to establish elsewhere. In our community, this is sufficient time. Patients are explicitly told we will not write after 60 days, and if there is a risk of withdrawal, they are warned about this, incl...

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Psychiatry · Oklahoma State University
Answered on

When I receive a refill request from someone who has been formally terminated from care, I treat it less like a medication decision and more like a boundary clarification with patient safety as the guardrail. Termination means the therapeutic contract has ended, and I am careful not to quietly re-en...

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