Example of “Just a Medicine Refill”:

     1.     Pharmacy faxes refill or patient calls the office

2.     Princess takes a message if pt calls office – patient’s problem, where she can be reached, what medicine, what pharmacy

3.     Princess pulls chart

4.     Princess attaches refill request or note to front of chart and lays it in doctor’s inbox

5.     Dr. Lasermed checks

          A. when patient was last seen (no refills if more than one year for some meds, 6 months for others … by law)

          B. when patient last received the medicine

          C. is it legal to refill over the phone / fax

          D. is there any reason why this patient should not have the medicine now?  Is she overdue for a visit or test?  Should she still have some medicine?

IF the medication is approved,

6. either the fax is filled out, or the pharmacy is called. 

7. There are two separate places in the chart where this needs to be noted – on the progress notes and on our “medication sheet”.  This is a separate part of our chart that has every medication prescribed since the mid 1990s. 

8. The chart is returned to Princess, who checks to make sure all of this was done.

9. A bill is generated if necessary – ya think?

10. The chart is filed.

IF the medication is not approved, the patient and pharmacy are called and an appointment is scheduled. 

This is a SIMPLE medication refill.

Wanna hear about a prior authorization?  I thought not. 

Refilling Other Doctor’s Prescriptions

A Physician’s Dilemma

I sometimes have patients ask me if I will refill a prescription that was written by another doctor.  This is a really difficult thing for any doctor to do.  Some doctors want to see the prescription first.  Most will just flat out refuse.

Here’s why. 

Often, the medication is something I am not familiar with.  I had one patient look at me in amazement and exclaim, “But you went to medical school, didn’t you?” Yes, but that was back in the stone ages.  A lot of today’s medicines weren’t available then.  That goes for medications in and out of my specialty.  I have tried to keep up with those in my specialty.  I have not been able to keep up with those out of my specialty.

Not only do I not know how to spell the medication, I don’t know what it is used for (indications), whether or not it will interact with any medication I might be giving you, what the doses are, when you shouldn’t take it (contraindications), what the side effects are or anything else about the medication.  I admit there are fancy computer gadgets that let me look that stuff up.  However, there is not enough time in an average appointment to look up every medication.

The other issue is WHY ARE YOU OUT OF THE MEDICATION?  Are you late to see your other doctor?  When did you have your last screening testing done?  Do you need an appointment to get your cholesterol or sugar or kidneys checked? How am I supposed to know if you are taking the right amount?   What if I refill it and it isn’t the right amount?  Your condition could get worse or you could DIE.  I would feel pretty danged awful about that. 

Nope, I’m not going to take the risk.  I will call the doctor who wrote the prescription and see if you can get an appointment.

And don’t even think about calling after hours or on the weekend.  I’ll need extra blood pressure medication for that!

Medication refills

Please check before you run out

I read a lot of other medical blogs.  This was posted on theangrypharmicist: http://www.theangrypharmacist.com/archives/2011/09/careastatin-0-refills-remaining.html.  She is on the receiving end of people who forget to refill their routine medications until they are out.  Often they are out for days.

Folks, we all know when the bottle is almost empty.  The bottle has the pharmacy number on it.  It has the name of the doctor that prescribed it on it.  If you need to call the doc, call when there is about a weeks worth left so that the process can be done.  If you haven’t been seen for a year, call when the bottle says NO REFILLS.  The doctor is going to need to see you. 

In some offices they will schedule your appointment, then call you in enough medicine to get through until you run out of medicine.  Other offices will want to see the whites of your eyes before you get another prescription.  Most doctors are no longer giving prescriptions after hours or on weekends, because they don’t have access to your records.  We no longer know our patients like your family doctor did 50 years ago.  We also don’t trust people.

I have had patients call for antibiotics and “a few pain pills”.  Then they only get the pain pills.  I have one patient who only calls on the weekend because she has a bladder infection.  I don’t know if she sees anyone else, but she never calls me when she could come to the office.  I finally stopped calling her in medications when I went to chart her weekend call and realized she hadn’t been in for almost two years, and had called me on the weekend about 4 times.

We have an expression: lack of preparation on your part does not constitute an emergency on my part.  Believe it.