Relationship W/ Psychiatrist and overstepping boundaries?

[Tomer]

Hey,

Would appreciate responses asap, as will be sending an email to my psych, later tonight.

So, my psychiatrist and I have a very good relationship and he sends me scripts for pretty much whatever I ask. I never abuse and always use them for their therapeutic abilities. The other big caveat is, I don't have insurance, and he simply lets me pay a minor fee in exchange for his services.

So, I'll get to my point, finally. I have had a very sore shoulder (lacks mobility at times) from overworking it through gym exercises. Is it unethical to ask your psych for an opiate prescription? Given the fact that I don't have insurance and it would be much more costly to go see a GP, I find my current situation much more appealing. Look forward to replies.

Cheers

 

[Miss_vanilla]

Hey,

Is it unethical to ask your psych for an opiate prescription? Given the fact that I don't have insurance and it would be much more costly to go see a GP, I find my current situation much more appealing. Look forward to replies.

Cheers

In a word, yes.

Your psychiatrist treats your mental health problems - they aren't specialised to assess physical or orthopaedic problems although they obviously would have trained as interns in their medical training. You need to have your shoulder assessed by a medical doctor or at the very least, rest your shoulder and use hot/cold packs.

I mean, I'm not in the US obviously and we have a different health system but I can't imagine any psychiatrist doing this.

 

[eukaryote]

In a word, yes.

Your psychiatrist treats your mental health problems - they aren't specialised to assess physical or orthopaedic problems although they obviously would have trained as interns in their medical training. You need to have your shoulder assessed by a medical doctor or at the very least, rest your shoulder and use hot/cold packs.

I mean, I'm not in the US obviously and we have a different health system but I can't imagine any psychiatrist doing this.

You mean like any one of the many specialties, which include psychiatry? Speaking as one, Physicians and Surgeons are Physicians and Surgeons first, specialists second. We all must be able to assess our patients for co-morbid conditions. We must be able to manage those co-morbid conditions while managing which ever is our primary concern.

What your psychiatrist feels she or he is able and willing to do is up them. But it is not unethical in any to present any medical issue to any physician. Maybe they will treat it, maybe they will send you to your GP or another specialist, but presenting alone poses no ethical or moral boundary crossed.

 

[Samadhi]

I agree with eukaryote - you can only ask - it's up to your practitioner to perform any kind of risk assessment.

 

[Miss_vanilla]

Well realistically the OP will need his shoulder assessed. At the very least a physical assessment, maybe even a scan, perhaps seeing a physio. They can prescribe pain medication but they won't necessarily be opiates. That's what would happen here ... you would see a GP then an ortho if it seemed serious. I've been through this with a knee injury previously.

I guess it was the term 'opiates' which bothered me as they are very strong, require a prescription and can be addictive if not managed properly. Why not anti-inflammatories over the counter first?

Maybe it's different in the US.

 

[bagochina]

My last psychiatrist scripted me opiates for years. I dont see it as unethical at all. You get banged up and are sore so you ask your doc for a small script. Either you get it or you dont, no biggie. That psych doc gave me just about anything i asked for. Always paid in cash.

 

[eukaryote]

Well realistically the OP will need his shoulder assessed. At the very least a physical assessment, maybe even a scan,

Well, realistically, that physician can conduct a visual and tactile examination and order and read a projection radiograph. At least if they actually passed their M.D./D.O./M.B.B.S./M.B. B.Chir/Whatever the bloody hell the former USSR calls theirs, degree, wrote their medical license and completed a residency in any specialty. If that Physician's findings indicate to his or her medical judgement that a different physician is needed; well I am sure they can write a referral. In the short term, if the patient is presenting with pain refractory to NSAIDs, than an Rx for opiate may be called for, awaiting the consult with the other physician. Not all opiates are very strong. I'd hardly call APAP/CAFF/30MG Codeine or 50mg Tramadol as being the same as the likes of sufentanil.

Example: I am in a surgical specialty, not family medicine or infectious disease. Never the less, I feel it would be utterly ethical and fine and if a patient complained of sore throat, I found fever and took throat swab for rapid antigen detection test, had it return positive and Rx'd for say, Amoxicillin or Erythromycin.

I fail to see how either the OP's question, nor how my hypothetical would be a breech of medical ethics. I am confidant that the College of Physicians and Surgeons would return in my favor should my hypothetical be the subject of a complaint.

 

[Tomer]

Yea, I sent him the email last night. As one other poster mentioned, the worse that can happen is he says no. I decided it's really not a big deal. Thanks for the replies

Cheers

 

[VanWeyden]

A bit ot, but I am really amazaed how easy it seems to get a opiate prescription in the US. I mean, pain from overworking in the gym? My orthopaedist would say "stop working out so much, take some ibuprofen if needed" and do a thorough examination, then treatment. No opies as long as I'm not crawling on the floor from pain...

 

[rangrz]

^

I think the issue there is the Rx given, not the presentation to a psychiatrist with an internal medicine issue. The Psychiatrist can make up his (Or her) own mind as to if and how to treat it. But I agree with the others who say asking a Dr, any Dr, for medical treatment of any problem is not it self, unethical.

 

[arctica]

What was the outcome of the email? I've found shrinks to be hesitant to prescribe non-psych meds, even non-addictive ones like migraine medicine.

 

[Jackal]

Hey,



So, I'll get to my point, finally. I have had a very sore shoulder (lacks mobility at times) from overworking it through gym exercises. Is it unethical to ask your psych for an opiate prescription? Given the fact that I don't have insurance and it would be much more costly to go see a GP, I find my current situation much more appealing. Look forward to replies.

Cheers

Leave the gym alone, rest the arm and take a paracetamol. Opiates for a sore shoulder??

Come on.

 

[rocknroll702]

he doesnt have the power to prescribe it but asking will only help u get referred somewhere unless u know where you can go already-

a MD doctor is required to prescribe that type of narcotic.

 

[Tomer]

What was the outcome of the email? I've found shrinks to be hesitant to prescribe non-psych meds, even non-addictive ones like migraine medicine.

He obliged. We have a good relationship. I never abuse any drug I take and whenever I receive medication, it can literally last me upwards of a year.

Cheers

Tomer

 

[Tomer]

Leave the gym alone, rest the arm and take a paracetamol. Opiates for a sore shoulder??

Come on.

Why shouldn't I be able to take an opiate now and then to relieve the pain? Im understating the fact of "sore". Its beyond that, but not to the point of a tear.

 

[eukaryote]

he doesnt have the power to prescribe it but asking will only help u get referred somewhere unless u know where you can go already-

a MD doctor is required to prescribe that type of narcotic.

Might I ask what you think psychiatry is a specialty of? Oh right! Medicine! After obtaining ones M.D....or D.O....or M.B.B.S. one does a residency in something, psychiatry is one of those options.

For the record, a Doctor of Dental Surgery can also write for Narcotics, as can a Doctor of Podiatry, in most jurisdictions.

Glad it worked out for you Tomer.

 

[Missykins]

Example: I am in a surgical specialty, not family medicine or infectious disease. Never the less, I feel it would be utterly ethical and fine and if a patient complained of sore throat, I found fever and took throat swab for rapid antigen detection test, had it return positive and Rx'd for say, Amoxicillin or Erythromycin.

I fail to see how either the OP's question, nor how my hypothetical would be a breech of medical ethics. I am confidant that the College of Physicians and Surgeons would return in my favor should my hypothetical be the subject of a complaint.

Unless the treating psychiatrist was treating the patient for substance abuse. It would still be in the patient's best interests to be seen by a physician accustomed to treating musculoskeletal disorders.

 

[nekointheclouds]

Its good that you two have a good relationship and i understand that you dont get the drugs to abuse, but that yuor honestly in pain. And you DR. has the right to perscribe you what he sees fit, there is no medical laws outlining what drugs a psychiatrist can and cannot prescribed. Hes licensed to practice medicine.

But what can start to get unethical in this situation is if he keeps just giving you pain meds and you never seek any care from a doctor you might actually be able to TREAT the source of the pain.I mean theres no reason to continuously take opiates to treat a sore shoulder from working out at the gym. Opiates dont treat any actual symtpoms of your shoulder, it just numbs you of the pain there.

Long story short, if you continuously take opiates to treat soreness from working out at a gym, this will only result in you being more likely to further injure your shoulder because you wont be feeling the pain that warns you not you use that arm. We feel pain for a reason, you need to treat that reason, not just kill the pain.

 

[PriestTheyCalledHim]

Leave the gym alone, rest the arm and take a paracetamol. Opiates for a sore shoulder??

Come on.

^Do this.^

You've got a sore shoulder from the gym. There's no need to take opiates for that.

I've strained and possibly torn a muscle and I didn't take opiates for it at all.

 

[Bucklecroft Rudy]

Psychs cant hand out opiates - it'd make for a lucrative cottage industry for sure. Script vulnerable patients addictive drugs watch as they spiral into a morass of addiction and be in the immediate vicinity when they self destruct. Anyhow they can recommend that you be prescribed non psychiactric drugs but to be perfectly honest after a 5+ year opiate addiction I would warn anyone off opiates for whatever reason. There are alternatives - maybe im just a masochist though