Monday, January 9, 2012

The more things change....

Massachusetts has lots to be proud of in the approach that the Commonwealth has taken to the implementation of the CBHI, with the acceptance of behavioral health screening in the pediatric office to the establishment of mobile EMH services throughout the state (nobody else is even thinking about that one!).  We are innovators, on the cutting edge of high quality services for children with serious emotional disturbances.

And yet....

Why do I get a call from an intensive treatment program about one of my patients, telling me that the child's psychiatrist left in October, that they have not identified a new one for this patient, and ask that I write prescriptions for his/her three psychotropic medications.  Why have I heard nothing about this patient for 8 months, while his/her psychiatrist manages his/her meds, and, upon leaving, assumes that I will continue the meds?  How do I monitor the effectiveness of therapy, when I have no evidence of this child's current diagnoses?  How do I monitor side effects, when I have never heard of one of the medications?  This is the sort of thing that intensive case management is supposed to prevent;  why did it fail my patient?

We build systems that are supposed to work.  We hope that this sort of thing is happening less frequently than before.  And we recognize that there are likely still a few bugs in the system.

Happy New Year!

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