Does Your Doctor Refill Prescriptions by Phone?

This blog was a little surprising after my two blogs on prescription errors, but we can always learn more. Yes, most doctors will not issue prescription over the phone and here are some instances when a doctor will not refill the requested medicine:

• One of his/her partner’s patients calls after hours for a refill on narcotics - they can become adictive.
• A patient wants a refill beyond his/her expertise. He/she won’t be refilling your cardiac medicines as this should be done by the prescribing physician for several self-evident reasons.
• He/she hasn't seen the patient recently.

Most doctors hesitate for valid reasons for wanting to see a patient before issuing a prescription(s). The author lists these six reasons:

1. Does this specific drug still make sense?
2. Can the dosage be lowered?
3. Have any new symptoms developed that might require diagnostic investigation? Suppose the patient has been losing weight, for example? What if the heartburn has worsened and a new disease is responsible?
4. Is the patient experiencing side effects from the medicine that he or his primary care physician might not appreciate?
5. Could the heartburn medicine interfere with new drugs that the patient is now taking?
6. Is the patient up to date on other issues within a gastroenterologist’s responsibility such as colon cancer screening?

Refilling routine medicines may not be routine and should be done with care and caution. The author uses this example - a patient from 2 years back who has GERD might think he needs Nexium for his heartburn. What if his symptom is actually angina? Get my point?

The author says, when we ask you to stop in for a brief visit, it’s not because we delight in hassling you or are hungry for your co-pay. We’re trying to protect you and to keep you well. Doesn’t this seem like the right prescription?

Some prescriptions can be written without seeing the patient if the patients keeps regular appointments. I have had this happen quite often. This is because I have been seeing the doctor almost quarterly for over 14 years and have always been up front with him. I needed some heavy duty pain killers, and for that he wanted to see me which I had no problems with this because my research had told me this would be necessary as the medication would be a narcotic and they don't like prescribing those. After doing an examination and another doctor had done a few tests, I was able to get my prescription and several refills.

When I asked that the strength be reduced about two months later, he did, but told me I would need to see him before any more refills. Since I would have an appointment two weeks later, I reminded him of that and he said he would prescribe enough to get me to that appointment. By my appointment, I was out and told the doctor I did not need any more as the pain had subsided a few days before. I am happy that I have not had any further pain and even the doctor is happy that I don't need the medicine.

Some Drugs Sold Without Safety Information

Do you know what to look for when you receive your prescriptions? In the State of Iowa, it is mandatory by law that the pharmacist tell you about your medications especially if they are new to you medications. Plus you have the right to ask about any medication and have them explain the printout if you have questions. Only once have I needed to do this.

For Consumer Reports to find discrepancies in information that lack crucial safety warnings means that some states need to revisit their prescription laws and rules that pharmacists must adhere to and up the penalties for safety violations committed by pharmacists.

The recommendation by Consumer Reports for a nationwide standard, similar to the Nutrition Facts labels on food packages or the Drug Facts labels on over-the-counter medication may be justified. Now, each state pharmacy board sets the rules, the report says. Especially since these findings are so poor when the requirements from the FDA that medication guides are always be included and even this is not happening.

I wish we know which states were included in the investigation, but that is for another day apparently or another report. The chain pharmacies all failed dramatically and you have to wonder when they say that one-third of preventable medication errors occur outside the hospital. I would have thought that this could have been larger, but when you consider that about 1.5 million preventable medication errors occur each year, this is still a staggering number.

According to Lisa Gill, prescription drug editor for Consumer Reports Health, the inconsistencies are difficult for every patient, especially when the font size used for printed material is so small it is often difficult to read. Another problem is all the medical jargon used tends to confuse patients.

The findings are concerning, says Allen J. Vaida, PharmD, executive vice-president of the Institute for Safe Medication Practices, an advocacy group who reviewed the findings for WebMD. He also stated the importance of talking to your pharmacist if the drug is new to you. Another trend by some pharmacies of promising a prescription will be ready in minutes is not a good trend.

Allen J. Vaida, emphasized asking the pharmacist the exact and best times to take a medication. If the directions say twice a day, does that mean at 9 and 3, or is it better to be taken at 9 and 9.

Read the report here. This may help you understand the necessity of getting clear instructions and checking your medications before leaving the pharmacy.