I actually engage in this myself. It's not "nice," I don't like doing it, but I have no choice when so many have normalized microglial dysfunction, neurotropic viral spread, and leaky blood-brain barrier related illness as they won't #WearAMask.
I had a patient show up either high on ketamine or manic, engaging in ideational flight, neologisms, rhyming, not making much sense, decreased need for sleep 6 days. No evidence of being obtunded or alterations in mental status.
I explained I wasn't prescribing them shit until they took an antipsychotic. Particularly when their drugs of abuse screen showed positive methamphetamine result on top of it (they didn't test for ketamine), not just amphetamine consistent with Vyvanse.
Patient engaged in splitting, and went to the PCP, pcp said he looked great (this was 2 weeks later by the way), probably had food poisoning, and delirium. 29yo with delirium from bad food, yeah that's common. "He should be put back on a controlled substance" and he says he ended the appointment with a hug from the patient.
As in, put on the medication again, by me.
Eyeroll.
So I laid it out to the PCP: surely since you are confident this was delirium, you are acquiescing to being the prescriber for his mental health needs correct? And by the way PCP, I did a confussion & assessment method evaluation, he showed no acute fluctuations in attention or alterations in mental status. I will not be prescribing the controlled substance.
The doctor to his credit realized the mistake he had made playing buddy buddy and maintaining poor boundaries, and found out that the patient had lied about someone else telling him to stop the antipsychotic. And that he would not be prescribing the controlled substance in question, or suggesting otherwise.
That's the kind of reality I am dealing with in an era of obvious #COVID19 compromise of the brains of individuals around me. This PCP is not a masker. I've no idea if this is a deviation from his baseline compared to 5 years ago, but I will absolutely treat him with skepticism because he is ignoring COVID & showing poor judgment.