Care of Legacy Patients

I posted this article in another thread re: the "Care of Legacy Patients", i.e. patients' care whose care is taken over by a physician after treatment was initiated by another provider. I believe this recent article published by the College of Physicians and Surgeons of Nova Scotia should also be included in the "Benzos in the News" section of this forum. The article was:

 

Approved by: Council

 

Approved on: October 15, 2021

 

Date of next review: 2024

 

https://cpsns.ns.ca/resource/caring-for-legacy-patients/

 

"Professional Standards and Guidelines Regarding Caring for Legacy Patients

 

Preamble

 

In this document, legacy patients are defined as those whose care is taken over by a physician after treatment was initiated by another provider.

 

The purpose of this document is to guide physicians on the challenges of caring for legacy patients. Physicians must both manage the expectations of legacy patients and independently assess the risk and benefit of their existing treatment plan. These challenges are particularly difficult when involving medication regimes that do not conform to current best practice standards or guidelines.

 

Professional Standards

 

Physicians must:

 

not refuse to accept patients to their care because of the medical condition of the patient or their treatment plan; and

assess the legacy patient and provide patient-centered care, tailored to the specific circumstances and needs of the patient.

Guidelines

 

Good care should always consider the individual needs and circumstances of the patient. To provide safe and respectful care to legacy patients in particular, physicians should:

 

consider patient autonomy in shared decision making around treatment expectations. The College encourages the use of agreed upon treatment plans that are documented in the patient record;

regularly review medication regimes and discuss the risks and benefits of medications with legacy patients;

where appropriate, engage the patient in a discussion about tapering of medications to promote a shared decision-making approach;

where appropriate, implement a tapering program that is individualized to patient need and circumstances; and

recognize that tapering is not always possible or appropriate. Vulnerable patients should not be destabilized by the imposition of tapering. There will be circumstances where patients cannot tolerate the effects of tapering or refuse to engage in tapering."

 

imo: a) the article fairly presents the medical ethics involved in the care of patients who were prescribed benzodiazepines by physicians who may not have been fully informed about some side effects of the long-term use of benzodiazepines including the potential for dependency when the medications were initially prescribed and b) the ethical medical considerations of tapering/cessation or continuation of long-term benzodiazepine treatment should be similar regardless of one's primary physical residency, be it in Nova Scotia or any other place.

 

Further, the article addresses the ethical guidelines that subsequent prescribers should consider when recommending tapering/cessation or continuation of benzodiazepine medication for "Legacy Patients".

 

 

While reading many threads and posts on this site I have noticed that many patients choose to stockpile benzodiazepines and/or taper/cease to use benzodiazepines speculating that they will be forced to cease using these medications at some unforeseen time in the future. 

 

While examining ethical medical considerations for the tapering/cessation or continued use of benzodiazepines in the U.S., I found this excerpt published by the American Medical Association:

 

"Code of Medical Ethics Opinion 9.6.6

 

In keeping with physicians’ ethical responsibility to hold the patient’s interests as paramount, in their role as prescribers and dispensers of drugs and devices, physicians should:

 

Prescribe drugs, devices, and other treatments based solely on medical considerations, patient need, and reasonable expectations of effectiveness for the particular patient.

Dispense drugs in their office practices only if such dispensing primarily benefits the patient.

Avoid direct or indirect influence of financial interests on prescribing decisions by:

Declining any kind of payment or compensation from a drug company or device manufacturer for prescribing its products, including offers of indemnification.

Respecting the patient’s freedom to choose where to fill prescriptions. In general, physicians should not refer patients to a pharmacy the physician owns or operates."

 

https://www.ama-assn.org/delivering-care/ethics/prescribing-dispensing-drugs-devices

 

imo a) speculating about unforeseen forced cessation of benzodiazepines is not in the best interest of patients and b) I agree with the College of Physicians and Surgeons in Nova Scotia's Guidelines to Physicians that good care should always consider the individual needs and circumstances of the patient and to provide safe and respectful care to legacy patients in particular. Sincere Best Wishes to All

 

 

 

If only that doctors would readily and gladly accept a prior doc's controlled substance patient (I worked in healthcare and they do not!) or give them a heads up that they were leaving their practice.  My doc closed her office on a Friday afternoon and left no contact information whatsoever and of course, no refills for her patients.  Thank goodness I was off benzos at that point but if I had not been, I had stockpiled some benzos for that very 'just in case' scenario.