How Do You Handle This in Your Practice?

[Contrarian]

Related question: Say a young pt is away at college; their only script is Retin-A Micro. Pt says it's working great on their skin and wants a refill, is that annoying?

 

Yeah... ok.

Then you get the letter from her OB stating that her amniocentesis in abnormal and asking you to send the copy of the last pregnancy test you ordered... since they already have copies of all 6 refills you authorized.

 

Fun times ahead...:sadface:

[Hemegroup]

For non-compliant HTN patients, I bring out my physiology texts. I have found that when you sit down and lead them through the glomerular/nephron apparatus and how the 'nets' get stretched and damaged permanently, ending with the good ol', 'and once you go on dialysis you have about 7 years to go' ... always works for me.

[Hemegroup]

For non-compliant HTN patients, I bring out my physiology texts. I have found that when you sit down and lead them through the glomerular/nephron apparatus and how the 'nets' get stretched and damaged permanently, ending with the good ol', 'and once you go on dialysis you have about 7 years to go' ... always works for me.

[mackjacks]

Yeah... ok.

Then you get the letter from her OB stating that her amniocentesis in abnormal and asking you to send the copy of the last pregnancy test you ordered... since they already have copies of all 6 refills you authorized.

 

Fun times ahead...:sadface:

 

They know I have an IUD, but when I first got the script I was on a combo pill and was surprised they didn't mention a thing about tretinoin and adverse pregnancy/breastfeeding risks. Lucky I am an educated consumer and currently parenthood-adverse.

 

Edit: But anyway, I'll make sure to go see them before school starts so I won't be swamped studying and asking for a phone refill!

[ventana]

commincation and certified letters always worked for me (I mail certified and first class same day exact copy so if they try to say they never got it and refuse to sign they still get a copy)

 

yeah really hard situation - a lot goes into this discussion - how long you have known the patient, do you think they are just in a tough spot or just using you. With a long term (many years) patient I am more liberal as there is a relationship there - a new patient - I have very little tolerance for - I admitted a noncompliant patient that other providers had basically written off for BS in excess of 600 - she spent 3-4 days admitted - pissed off about it initially, but in the end she thanked me for finally getting her to see the light - course wonder how long it will last but at least I tried.

 

 

 

I think you follow your gut and document with good intent and send certified letters and let the chips fall where they do. I can not be everything to everybody and I am comfortable with this - however I am a generalist and there is other providers in the area - not sure what to do with a subspeciality practice where you really are the only choice - my hunch is that you still have to have laws and guidelines and follow them otherwise you become a doormatt with a script pad.

[jmj11]

We (in headache) have always had a special grace for cluster headache patients because, when not treated rapidly, have a significant suicide rate. Last year I had a patient who suddenly went back in cycle and called for his # 8 sumatriptan injections. I gave him 8 and told him he had to schedule before i gave him more (it had been over a year since I had seen him). I also asked him about any new health changes and he denied any. Then he canceled his appointment (he is a CEO of a major local company requiring him to travel abroad a lot). I denied his sumatriptan refill. He was livid. Finally he came in for his appointment and to chew me out. During the visit I asked about any new meds. He was put on a beta blocker. "Why?" I asked. "After I had my heart attack last year." was his response.

 

Do I believe that sumatriptan provokes subsequent MIs. Extremely unlikely. I personally wouldn't hesitate to use sumatritpan after an MI but just for myself. Do I believe that the grim reaper might roll the dice and this man's number come up . . . then his lawyer blames me for Rxing sumatriptan . . . likely and terrifying. So it was a good teaching point for the man, who said that I wanted him to come in just to make money off of him.

[Contrarian]

... [brevity edit] ... he is a CEO of a major local company requiring him to travel abroad a lot....

 

... [brevity edit].. the man, who said that I wanted him to come in just to make money off of him.

 

Kinda ironic... don't ya think...???

 

Seems of all people... that he wouldn't/shouldn't have a problem with this IF it were true.

 

Human behavior always amazes.

 

That said.. your story is a EXCELLENT example of why its NOT a good idea and can be considered bad form to keep refilling RXs of patients we haven't laid eyes/hands on at regular intervals.

[ToppDog]

Agree with the above, which is why I loved the approach done by the doc I mentioned above. Making it extremely inconvenient while at the same time allowing patients to get their meds until they showed up (for a short period of time of course) was a good solution, I thought.

[Elysium1973]

This is also an issue in our practice, and it's kind of a mess bc we have 4 docs and me in a busy FP practice. The clinic has

been around for 40 years, and the old retired docs where pretty bad about phone medicine.

I am pretty strict about my own patients and so is my SP. if its been a year and they need BP. Meds I write for 15 and my MA calls them and puts them on the schedule. If they miss the appt, they are out of luck. Narcotics is every three months and they sign a pain contract. It's very frustrating foyr sure!!