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Hello,

I am a family practice PA, and I cannot find anywhere at all stating whether or not I can write a letter for an emotional support animal. I know DO, MD practicing family medicine can and doesn't need to specifically be specialized in psychiatry etc can write one, so would that apply to us as PAs as well. Thank you. 

Cameron Hardy PA-C

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As far as I know, anyone can write one.  The trouble is, once you write one, word gets around that you are the go-to person, and then eventually, you are getting all the support animal letters, all the "chronic lyme" patients, all the custom thyroid patients, all of them. 

Do this: Once they start talking, let them go for a bit.  Nod once in a while.  Then break in at an appropriate spot, and say "I agree.  This is such an important subject, I don't want to mess it up, so I'm going to refer you to <MH provider here>."

It gets you on to lunch (because they always schedule before lunch).  It gets you a friend for life by the MH professional you just sent them to.  

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51 minutes ago, thinkertdm said:

As far as I know, anyone can write one.  The trouble is, once you write one, word gets around that you are the go-to person, and then eventually, you are getting all the support animal letters, all the "chronic lyme" patients, all the custom thyroid patients, all of them. 

Do this: Once they start talking, let them go for a bit.  Nod once in a while.  Then break in at an appropriate spot, and say "I agree.  This is such an important subject, I don't want to mess it up, so I'm going to refer you to <MH provider here>."

It gets you on to lunch (because they always schedule before lunch).  It gets you a friend for life by the MH professional you just sent them to.  

LOL this is definitely a reply from a seasoned provider. Read it earlier and have been cracking up about it all afternoon. So much truth in this its sad. I'm in Vernal and word spreads quickly, I'll be doing letters all day. I will just defer because I am sure you are right. And truth be told it isnt someone I felt needed it anyway. I was just hoping to use some law that says I can't, but I'll just have to be the law in this case.

 

Thanks

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24 minutes ago, camhardy said:

I was just hoping to use some law that says I can't, but I'll just have to be the law in this case.

Yeah, I thought that way too earlier in my career, but really, the older I get, the more comfortable I am saying "No, I'm not going to do that, because I don't believe [It meets criteria | It's really in your best interest | it's fair | I would be telling the truth]"  ESA letters aren't real big deal, but you need to learn to say "no" if you're going to prescribe opioids safely...

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nope, nada

 

so much abuse that i simply refuse.  If someone has a true service dog I will write a letter, and those are easy to see.

The Emotional Support ones,   yeah please leave the office

 

We have actually banned ALL animals from out office.  We will let true working dogs in, but all others get turned around at the door.   

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I write the letters.

Simple phrasing, no release of detailed medical info.

”Ms/Mr Smith receives medical care at XYZ Facility.

He/She has a medical condition that would benefit from a companion animal in their residence.

Please consider it medically appropriate for a companion animal for this person.”

I avoid the term emotional support and use companion animal.

If the person has more serious psych issues or I have the least bit concern that the animal is not ok in this situation - I defer to the psych/PhD that the patient should have. 

A truly trained service animal should have certification from a training facility and not need a letter from me.

I have never written a letter for an animal on a plane. I tell patients that cats/dogs should fly under normal regulations under the seat in a carrier following all rules. I personally don’t ever want an animal stowed in the hold - not a good thing ever for me or the animal.

It has worked out well so far. 

Somehow, no one has ever asked to cite an emu, giant lizard, turkey or other bizarre creature as medically necessary….. it will happen at some point.

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Yes service animals are a different subject. I'm not sure they even need a letter because they are formally trained and certified and are protected by law.

Most of the people who asked me wanted to not pay a pet deposit in their apartment or let their comfort gerbil go in a dining establishment etc.

 

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I might start an online medical consulting business specializing in support animals. You can send all your patients to me. I'm afraid the full evaluation will cost several thousand and not be covered by insurance, but if it helps Karen bring her dwarf giraffe along on her next United flight, I think we can all agree it will be money well spent. 

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Dwarf giraffe, hamsters lol I am glad I asked about the letter, this has been some of the best replies I've ever seen. I may just write the letter to get my name out there as I worry I may miss out on some ridiculous requests and visits. Not that I don't already have a schedule half full of that anyway.

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12 minutes ago, CAAdmission said:

I might start an online medical consulting business specializing in support animals. You can send all your patients to me. I'm afraid the full evaluation will cost several thousand and not be covered by insurance, but if it helps Karen bring her dwarf giraffe along on her next United flight, I think we can all agree it will be money well spent. 

we could combine it with my "how long do you need a work note for?" business. Enter your disease, required time off, and credit card information and your work note will arrive by email in 5 minutes.

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34 minutes ago, camhardy said:

Dwarf giraffe, hamsters lol I am glad I asked about the letter, this has been some of the best replies I've ever seen. I may just write the letter to get my name out there as I worry I may miss out on some ridiculous requests and visits. Not that I don't already have a schedule half full of that anyway.

One of the very first times I was asked to do a letter a woman came in with this...creature... it was a molting old chihuahua. It was half bald, blind from cataracts, had one tooth left, trembled like it was having a seizure the whole time, an peed and crapped in the exam room as well as on the patient and exam table.

She wanted me to write a letter that it was her emotional support dog.

No.

Turns out she was moving into a "no pet" building and was trying to game the rules by giving this thing some sort of legal status.

No.

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On 6/10/2021 at 8:35 PM, ventana said:

nope, nada

 

so much abuse that i simply refuse.  If someone has a true service dog I will write a letter, and those are easy to see.

The Emotional Support ones,   yeah please leave the office

 

We have actually banned ALL animals from out office.  We will let true working dogs in, but all others get turned around at the door.   

So where is that line drawn? What if I turned away someone that I thought was not mentally fit to take the morning after pill? I am TRULY not stirring s**t, but trying to understand why you would deny some and right out ban something that may help ones trauma/PTSD/anxiety/agoraphobia, etc. I think a referral to psych. is the least you could do, not just ban them as you think or believe in their mental health to even discuss a service animal (and yes a ESA is providing a service to that patient). I hope we can have a open and honest discussion on this topic so we can all learn from each other. Thank you! 🙂

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27 minutes ago, camoman1234 said:

So where is that line drawn? What if I turned away someone that I thought was not mentally fit to take the morning after pill? I am TRULY not stirring s**t, but trying to understand why you would deny some and right out ban something that may help ones trauma/PTSD/anxiety/agoraphobia, etc. I think a referral to psych. is the least you could do, not just ban them as you think or believe in their mental health to even discuss a service animal (and yes a ESA is providing a service to that patient). I hope we can have a open and honest discussion on this topic so we can all learn from each other. Thank you! 🙂

unsure how not allowing dogs, cats and any other creatures in the office has anything to do with the morning after pill

 

I "draw the line" that we are a private practice, that we have 20+ years of patients taking advantage and it got out of control and they were clearly NOT true service animals.  As well a life threatening allergy started it.  So nope we do not allow any animals (except prior stated true service)     Funny is we really no longer have people even trying.  They know we do not allow it and they do just fine.  It is sort of like not prescribing meds over the phone on the weekends.  Hard transition because your patients expect it, but once they learn it is a no go it is pretty easy.  (yes we still refill essential meds enough to get to the the next week then they have to come in)

 

As for providing a letter for an ESA (which is HIGHLY doubtful to begin with) as a "Service"  Well as a fine preceptor told me early in my career "medicine is not burgerking, you don't always get it your way"    Would you provide the service of writing for 90 tabs of oxy simply because someone asks you?  Is that not a similar thing?  They want it, we can give it to them, but we use medical judgement to decide if it is appropriate.   

 

Honestly I have been asked well over a dozen times for these letters and almost every single one is trying to get around a "no pets" policy.  Many times after they get caught with an animal they were not supposed to have.  Sorry, nope.

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21 hours ago, ventana said:

 Would you provide the service of writing for 90 tabs of oxy simply because someone asks you?  Is that not a similar thing?  They want it, we can give it to them, but we use medical judgement to decide if it is appropriate.  

I got asked for a med escalation for a patient on Friday, and I politely declined.  I got F-bombed until I left the exam room, which is, interestingly enough, the first time that has happened to me.

I never doubted the patient really was in pain, but that doesn't mean granting an increase was the right thing to do, and it absolutely was not going to happen after she started cussing me out: not because I have some sort of "bow down before my mighty DEA number" complex, but because patients who can't actually behave nicely when told "no" really need some other intervention.  MED was 108, if that matters.

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On 6/11/2021 at 9:50 PM, ventana said:

unsure how not allowing dogs, cats and any other creatures in the office has anything to do with the morning after pill

 

I "draw the line" that we are a private practice, that we have 20+ years of patients taking advantage and it got out of control and they were clearly NOT true service animals.  As well a life threatening allergy started it.  So nope we do not allow any animals (except prior stated true service)     Funny is we really no longer have people even trying.  They know we do not allow it and they do just fine.  It is sort of like not prescribing meds over the phone on the weekends.  Hard transition because your patients expect it, but once they learn it is a no go it is pretty easy.  (yes we still refill essential meds enough to get to the the next week then they have to come in)

 

As for providing a letter for an ESA (which is HIGHLY doubtful to begin with) as a "Service"  Well as a fine preceptor told me early in my career "medicine is not burgerking, you don't always get it your way"    Would you provide the service of writing for 90 tabs of oxy simply because someone asks you?  Is that not a similar thing?  They want it, we can give it to them, but we use medical judgement to decide if it is appropriate.   

 

Honestly I have been asked well over a dozen times for these letters and almost every single one is trying to get around a "no pets" policy.  Many times after they get caught with an animal they were not supposed to have.  Sorry, nope.

I don't see a link between a high abusive and deadly drug (oxy) to a dog that makes someone feel good...to each their own, but these topics come into play all the time. Where I gave a example above about the morning after pill, some hospital (religious) do not do that or some providers as well. I have heard arguments that they should be mandated etc. but how is this not a "service" as well. A 15 year old can demand a EC pill and get it, why cannot a 55 year old with PTSD "demand" a service animal?

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12 hours ago, camoman1234 said:

 I have heard arguments that they should be mandated etc. but how is this not a "service" as well. A 15 year old can demand a EC pill and get it, why cannot a 55 year old with PTSD "demand" a service animal?

Anything that forces a provider to do something they do not want to do is a losing proposition. 

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