Shirah Vollmer MD

The Musings of Dr. Vollmer

Transferring Care

Posted by Dr. Vollmer on November 1, 2011

   Bella, twenty-four, has seen me since she was fourteen, when she was in the ninth grade and started to fail in school, after an academically successful experience in elementary and middle school. Bella’s mom knew she needed medical attention, so after many physicians, the two of them, along with Bella’s dad, landed in my office. She was a relatively straight-forward case of ADHD. After much hesitation from her parents, she went on Ritalin and her grades rapidly improved. Bella, it turns out, had a similar history to her biological first cousin who also had a robust response to stimulants, but Bella’s parents found this out after Bella started treatment. Fast-forward ten years and Bella has just started medical school in another state. She is doing very well, although she is struggling with getting her stimulant prescription filled. She reports that the doctors at Student Health Services do not “believe” in giving stimulants for students to do better at school. I send a summary of my medical records, which reviews my extensive evaluation process, her response to treatment and my contact information. Apparently, according to Bella, this is not good enough. They need more information. “What would they like?” I ask, knowing that I have fulfilled my legal requirement to give a summary of the medical records to the next treating physician, at the patient’s request. “They want to talk to you,” Bella says with tremendous frustration. “That’s fine,” I say, “but when I call they are not available, and they won’t put patient information on email, so I am not sure what else I can do.” I say, feeling bad for Bella, understanding her stated predicament. “I can send you prescriptions, but we will need phone sessions,” I say, knowing that phone sessions are always my second choice, given that face to face communication is so much more valuable, therapeutically speaking.  

    Transferring care is a challenge. Relationships with providers, like all relationships, are unique and hence they are hard to replicate. Bella may be at a University which is particularly antagonistic to prescribing stimulants to students, and/or Bella could be resisting the change in how she was getting her medication. Maybe, in other words, she misses our relationship. It is hard to say. I will talk to her about that this week. We have known each other a long time. I have watched her grow up and now, perhaps, I will watch her develop as a physician. If the stress of renewing her prescription leads us to return to work together, maybe this is a good outcome. On the other hand, she may need a physician closer to school. It is a tough call. We will see how it goes. One thing seems certain: Bella’s determination will serve her well. She is on a good path.

2 Responses to “Transferring Care”

  1. Shelly said

    from what you are describing, she doesn’t seem resistant towards getting her prescriptions in a new way. Haven’t I heard it said that to admit any type of medical or mental disability is a stain on your record? Perhaps she doesn’t want anyone at the university to know she takes Ritalin?

    • Yes, that is true, although I am left to wonder why getting Ritalin is so challenging. As you say, it could be based on her fears, and it could be a reluctance from Student Health, but it could also be a deeper resistance on her part which makes her blind to certain avenues of help.

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