Professional Boundary Communication for Non-Active Patient Requesting Medication Guidance
You cannot provide medication recommendations or adjustments to a patient who is not currently active in your practice, and she must be seen for a comprehensive assessment before any treatment decisions can be made, particularly given her pregnancy status.
Suggested Message Template
"Thank you for reaching out. I understand your concerns about your medication during pregnancy. However, since you are not currently an active patient in my practice (our last appointment was [DATE], and you were referred elsewhere for ongoing care), I am unable to provide medication recommendations or approve changes to your regimen at this time.
Managing psychiatric medications during pregnancy requires a thorough clinical assessment that must be done in person. 1 This includes reviewing your current symptoms, pregnancy status, medication history, and developing an appropriate management plan that involves coordination between psychiatry and obstetrics. 1
I have an appointment available in two weeks, and I recommend you keep that appointment so we can:
- Complete a comprehensive evaluation
- Discuss the risks and benefits of continuing, adjusting, or discontinuing your medication during pregnancy
- Develop a safe management plan moving forward
Until we meet, I cannot advise you to make any changes to your current medication regimen. If you are experiencing a psychiatric emergency or have urgent safety concerns, please contact [emergency psychiatric services/crisis line] or go to your nearest emergency department.
If you need care before our scheduled appointment, I recommend contacting your OB provider or the [PROVIDER] you were referred to previously, as they may be able to see you sooner.
I look forward to working with you at our upcoming appointment."
Clinical Rationale for This Boundary
Legal and Standard of Care Requirements
Pregnant patients with psychiatric conditions require coordinated care between psychiatry and obstetrics with ongoing monitoring and medication adjustment throughout the perinatal period. 1 This cannot be accomplished through messaging without an established patient relationship.
Medication management decisions during pregnancy must weigh the risks of medication exposure against the risks of untreated illness through individualized treatment planning. 2 This requires a current clinical assessment, not remote guidance.
Safety Considerations
Medication regimen changes should ideally be reviewed before becoming pregnant, not after pregnancy is established. 1 Since she is already pregnant, this requires urgent but careful in-person evaluation.
Moderate to severe psychiatric symptoms during pregnancy warrant referral to a reproductive psychiatrist or general psychiatrist for medication management considerations. 2 You cannot determine severity or safety concerns without a current assessment.
Documentation Protection
Providing medication advice without an active patient relationship and current assessment creates significant liability exposure, particularly in pregnancy where both maternal and fetal outcomes are at stake. 2
The lapse in care and her non-response to previous appointment offers further supports the need to re-establish the therapeutic relationship before making clinical recommendations.