Thread by @DrKMSimon

Clinical Encounter:
Pt: I'm not feeling great.
Me: Yea, you don't look it.
Pt: I told doc, I wanted to taper off Suboxone 😔
Me: Which opioid were you struggling w/b4 here?
Pt: Fentanyl
Me: What's your Suboxone dosing?
Pt: 2mg (3x/day)
Me: How long you been struggling w/Fentanyl?

Pt: Few months.
Me: We're probably under treating you. So, I'm the wknd doc & essentially do check-ins w/folks. I don't like pts feeling 🤮 We need to go up in dosing. Cool w/that?
Pt: 🤔 Yea.
Me: Ok. Sry to get technical, but, I like pts to know the what/why behind my thinking.

Me: 2mg - 3x/day is kinda barely giving your 🧠 a rest. So - you're feeling 🤢 I believe you'll feel better on 12-16mg/day. Let's do 4mg - 3x/day. You got 2mg already, let's do a 1x - 2mg now (give me a few mins to order), oh & you should take a Clonidine now.
Pt: You sure?

Me: Yeah. [I scribble on a paper] We need to cover more of your 🧠 receptors. Not your fault. We can help. K - it's ordered. Let's walk to the med window. ✊🏽 Knock - Knock. Hi, I just put orders in for Mr/Ms ABC Doe. Ok. I'll check back in 30mins.
#MedTwitter

Despite some narrative. Pts w/ MH|SUD conditions are more than capable of understanding pharm|psych principles. We have to be able to describe info & meet them where they are. I enjoy teaching pts in all settings. [Really, it ensures I'm solid in knowledge.]

~45mins later
Me: How you feeling?
Pt: [Eating] Much better. Thank you.
We: Elbow bump.
@DrSarahWakeman @DrKimSue @DrAyanaJordan @DrScottHadland @JonathanMetzl @DrDaniJackson @la_kops @MaxJordan_N @DrRachelAlinsky #MentalHealth #SubstanceUseDisorders #EvidenceInformed #MedTwitter