Patient Perspective on Refills

Med renewal appointments are supposed to be quick.  How hard can it be to verify that everything is okay, then write a new prescription?

Although I’d love to have my pharmacy fax my doctor about my prescriptions, doctors want to periodically examine the patient before authorizing more refills.  It doesn’t take very long reading medblogs to realize that there’s a reason my doctor won’t okay refills over the phone (or fax).  Maybe something has changed and the dose needs to be tweaked.  Maybe the medicine isn’t effective, so a different one needs to be tried.  Medblogs are great for learning the reasons that doctors offices do some of the things they do.

It’s one thing to read about it in theory, it’s another to experience it.

At a recent appointment, I asked for a renewal on two prescriptions.  Simple, straightforward.  That was the whole purpose of the appointment; I figured it would take five minutes.

One medicine is a headache prophylactic that I’ve taken for three years.  As usual, my doctor asked about headaches.  Normally I say there have been none, then he writes the renewal.  This time, however, I mentioned that I’d been having headaches, but figured out that it was due to the muscle relaxant I’d been taking.  I quit taking it, and have had no headaches since then.

While this was good news in obtaining a renewal on that med, it threw a wrench in the works for the other medicine that I wanted more of.

That second medicine was to treat a rash.  That rash was thought to be from a medication interaction.  If you start taking a new medication and subsequently develop a rash, then it makes sense that the med might have caused the rash (especially when it’s listed as one of the med’s possible side effects).  It also makes sense that discontinuing that med would make the rash go away.  If you discontinue the med, but the rash continues to get worse, then maybe the rash was caused by something else.

I knew that, but I don’t care.   I don’t care what the rash is.  I don’t want to know.  I don’t want to go to more doctor’s appointments.  I don’t want to have more tests.  I don’t want to incur more expense.  I don’t want another diagnosis.  I am done!  All I wanted was for my doctor to write a prescription so I could refill my meds (so that I can have little round scars on my legs instead of ugly bleeding sores).

Apparently, good doctors care what a rash is, even when the patient would rather not know.  I don’t want to go to more doctor’s appointments – but I have a referral and the appointment is already scheduled.  I don’t want to have more tests – but the doctor will probably want to run some.  I don’t want to incur more medical expenses – but all of this is going to cost money.  I don’t want another diagnosis – but it looks like I’ll walk out of there with one anyway.

Last week I checked in at my FP‘s office expecting my doctor to renew two prescriptions in a very quick appointment.  He did write those prescriptions, but that half-hour appointment wasn’t quick.  This is incredibly frustrating.  Request for med renewals aren’t supposed to be snowball appointments.

Keeping My Thoughts To Myself

We’ve all heard that old joke, “Doctor, it hurts when I do this…”  The doctor responds, “Then don’t do that!”

We laugh, but I’d sure like to see that thought process expanded.  If a medicine is thought to cause adverse effects, why is the solution to add another medicine in hopes of controlling those adverse effects?

Off to the pharmacy I go:

Three weeks later:

Scheduling

“I can fit you in at 9:40, 10:40, or 11:40 this morning, or at 1:30 this afternoon,” came the voice over the phone lines.

Thinking to myself, “I don’t have time for another doctor’s appointment,”  I instead said, “Today’s schedule is pretty full.  Do you have anything available next week?”

“If you rheumatologist asked you to see your primary care doctor, we’d like to fit you in today,” was the response.

I sighed.  “Well, I can’t get there by 9:40, and 11:40 won’t work, so I’ll be there at 10:40 if it really needs to be today.”  A little voice in my head nudged me: this is backward; usually the patient pushes for same-day appointments, and the doctor’s office says it isn’t possible.

As I hung up the phone, I sighed again.  It seems like those same-day appointments should be saved for people who have an urgent problem needing immediate attention.  I don’t.  Nonetheless, I rearranged a few commitments, dropped my sons off so they could play racquetball instead of sit in a waiting room full of sick people, and then headed to my doctor’s office.

Arriving five minutes early, I signed in and sat down.  I waited.  And waited.  And waited some more.  People trickled in and the chairs filled.  At 11:05 I asked the receptionist if she knew how far behind the doctor was running.  Not that I care (or she ever knows), but there is a sign saying to ask:

By 11:20 I was wondering if I’d have to leave without seeing the doctor.  At 11:30 I stood to ask the receptionist to reschedule me, but the door opened and a nurse called my name.  I stepped into the hallway, away from eavesdroppers, and explained that I had somewhere else I needed to go and wasn’t sure if I should stay.

The internet is full of patients ranting about doctors who only schedule ten minute appointments, who will only address one problem per visit, and who feel that the doctor cuts them off when time is up.  My doctor isn’t like that.  Appointments are twenty minutes. All issues are addressed.  There are no clocks in any exam rooms and the doctor takes as much time as is needed.  That might explain why he was an hour behind schedule.

The nurse assured me that it should only be a little longer and showed me to an exam room.  “I love the fact that he takes time with people instead of rushing,” I smiled, “But I have a 12:00 meeting.  I’ll reschedule if I need to leave.”

Shortly after that, out in the hallway I overheard the nurse talking to my doctor.  A few seconds later, there was a knock on the door and the doctor entered.

I can’t imagine what it would be like to start every day knowing that your carefully crafted schedule was really only a rough outline.  I try to be flexible.  My doctor has taken extra time with me, so I can’t get upset when he does it for someone else.  It was hard, though, to allow a full hour of extra time and end up feeling rushed.