13 May NU677 WEEK6 Discussion Board
You have a psychiatric evaluation for a new patient scheduled for today. The patient is a 25-year-old female medical student at the facility affiliated with your clinic. The patient requested a virtual visit as she did not want to be seen entering your office.
You introduce yourself and establish the role that both of you have in treatment. The patient, Katie, interrupts, and states, “I have been treated for anxiety and depression before. I know what works for me. I have been off medications for 2 years and doing okay until recently. My primary care doctor has retired and will no longer prescribe my medication for me. I am applying for residency programs and my anxiety has been high, but I don’t want my diagnosis on my chart. I don’t want my anxiety and depression diagnosis to get in the way of matching.”
Katie reports she has been feeling tired, losing weight, lethargic, feeling sad, and overwhelmed. She is having difficulty concentrating and getting out of bed to make it to class and rotations on time. She is constantly worried and has an upset stomach. “I feel like I could puke at any minute.” She states she thinks the pressure of the third year of medical school is getting to her.
Katie denies ever having suicidal thoughts. She reports this has happened twice before- once in high school and once in college. She reports she was put on sertraline and able to “snap out of it.” She has never done medication in combination with therapy before but knows how important the combination of pharmacologic and non-pharmacologic treatment strategies is.
She is very concerned about having a diagnosis of depression and anxiety on her chart and asks if you can put premenstrual dysphoric disorder or menstrual irregularities. She says she will find a way to pay for therapy out-of-pocket rather than seeking insurance reimbursement, which would create a record of the depression.
Katie will need to apply for medical licensure in whatever state she pursues residency in and in whatever state she practices medicine after that. She notes that medical licensing boards in many states continue to ask if applicants have any history of depression, as well as whether they currently are suffering from depression, and answering “yes” could slow down or even result in the denial of her application for licensure.
Katie gives you a new list of symptoms consistent with the DSM-5-TR diagnosis of premenstrual dysphoric disorder.
She reports her primary care physician would prescribe sertraline for “menstrual irregularities” for both previous depressive episodes to avoid having a depression diagnosis on her chart.
As the treating nurse practitioner, how do you proceed?
Is honoring her request a fraudulent practice? What is your rationale?
What, if any, laws or regulations would you be violating?
If you do not feel this is fraudulent, why not? What is your rationale?
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