So I recently found out that I made a mistake prescribing a patient medication. (I'm in primary care and addiction medicine in a community health clinic). This patient had been previously diagnosed by rheumatology as having possible RA vs scleroderma but had not followed up with them in over 2 years and had been on plaquenil all that time. She came in complaining of severe bilateral joint pain in her shoulders which were extremely tender to touch with limited ROM. I tried to call rheumatology but was unable to reach anyone for consult, so decided to start the patient on methotrexate with leucovorin and get her in to see the rheumatologist ASAP. However, though I sent the referral, it took them 3 months to actually see her. I was monitoring her CBC and CMP as required while on methotrexate therapy and she seemed to be responding well and her labs were all normal. I had realized somewhat late that typically methotrexate is prescribed by a rheumatologist and not a PCP, but she seemed to be doing well so I figured I might as well continue.
Well, the rheumatologist recently emailed me after the patient missed her appointment and we discussed the current treatment. She told me that while she could tell I was trying to help the patient, this was NOT appropriate, the dose was too low and the leucovorin would counteract the effects of the methotrexate anyway (Epocrates led me astray: said it should be prescribed with the methotrexate but I guess it's better to do folic acid 1mg).
Although the patient wasn't hurt, I feel really bad about it, and I just need to hear some mistakes other people have made in their careers and what the process was like of getting through the beginner phase.