PMHNP is going to lose it if her Facebook post ends up on one of those "anti-NP" websites

If you're worried that you might totally lose it if your rambling Facebook post ends up on one of those "anti-NP" websites, then maybe you should have not blasted it for the whole wide world to see in the first place. You never know who might be watching - other nurse practitioners, physician assistants, foreign intelligence operatives, and yes - even deep-cover physician moles.

The "you" in this case is actually psychiatric-mental health nurse practitioner (PMHNP) Rebecca Feck, who operates MindWell Mental Healthcare in Lexington, Kentucky. Weighing in at 412 words long, Ms. Feck's Facebook post is reminiscent of the essays one had to write in high school, although we can say without a doubt that our high school essays were much more coherent and got to the fucking point a hell of a lot faster.

Length, grammar, and spelling mistakes aside (it's GeneSight®, not genecyte), Ms. Feck's approach to medication (mis)management is nothing short of horrific. She bills herself as an "experienced provider" and advertises on her Psychology Today page that she specializes in "thorough Psychiatric evaluations, mental health diagnosis, and safe evidence based medication management". One would think that an "experienced provider" would know that consulting the Facebook peanut gallery for medical advice and disclosing specific clinical details that could potentially be used to identify a patient is highly inappropriate, but, alas, this seems to be standard operating procedure for midlevels, particularly nurse practitioners. Ms. Feck's idea of safe, evidence-based medication management in this "difficult-to-treat" patient with the psychiatry variety pack of "PTSD/MDD/GAD/ADHD/learning disability" is to increase one medication (Latuda) and lower another medication (lamotrigine) at the same fucking time.

The concept of making slow, methodical, one-at-a-time changes to medications is constantly hammered into medical students and resident physicians, and for good reason - one has little to no idea how to discern the effects of multiple medication additions, changes, or subtractions made simultaneously. To no one's surprise, Ms. Feck's rationale for doing so - "I have tried so many things with her my thoughts were - that maybe the lamotrigine is making her worse and I need to increase the Latuda" - is so laughably feeble that it amounts to little more than medical experimentation. We'd cite the Hippocratic Oath here and the idea of "do no harm", but then again, the ancient Greeks didn't have to worry about an army of midlevel providers running amok.

Someone, preferably a board-eligible/board-certified psychiatrist, needs to walk into Ms. Feck's office and kindly inform her that heavy-hitting antipsychotic and psychotropic medications are not Venetian blinds that you can just raise and lower on a fucking whim. In all likelihood, making more medication changes after only 5 days (!) is a recipe for further trouble, especially in this complex patient whose diagnoses may be in question (why were they on lithium before?) Nurse Practitioner Feck claims that her patient is not suicidal, but in case this poor 35-year-old lady decides to off herself, we here at MidlevelWTF will preserve Ms. Feck's Facebook post for posterity in case the patient's family, the Kentucky Board of Nursing, or law enforcement comes knocking. Perhaps Ms. Feck should refer this patient to a real psychiatrist, i.e. a physician with an actual MD/DO medical degree, before it's too late.