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.
∞ itis 
I am so sorry. Yes, the last thing any of us want is yet another diagnosis. None of this is easy. Sending warm thoughts your way to at least help you deal with the stress and frustration.
Thanks, Carla. After my doctor wrote the referral, I asked if he has a guess what this is, and his guess is psoriasis. What is so frustrating is that I’ve thought for over a year that I have PsA, too, but my rheumy said it doesn’t matter. When I repeated that belief this past fall, she said the same thing – except added that the treatment is the same; the only difference would be that I shouldn’t take hcq since it can make psoriasis worse. So I stopped the hcq and a few months later my skin went nutso. I think that’s a vote against psoriasis, but then IANADSWDIK. Good luck Tuesday.
Yes, this exactly. I had this kind of appointment this week and I was shrieking inside my head. You have my sympathies.
Thanks, Lisa. I think your situation is more frustrating than mine. Hope it all gets sorted quickly.
The concept of refills is always interesting and peppered with semantic challenges. Doctors vary considerably in their approach to prescribing chronic medications. My frame and that which I like my office staff to embrace is simple (ish).
As a Family Physician, I diagnose and treat diseases and conditions-sometimes with prescription medication. If the natural history of the disease or condition is very long, I add refills for the pharmacist to act on if requested by the patient. The patient is expected to actually get the medication refilled for the chronic continuing diseases. When the refills are out at the pharmacy, that is a point in time when I need to reevaluate the status of the disease or condition in person with the patient. Drug-drug interactions are critical considerations at each visit of a patient with multiple drugs, doctors and diseases.
I prescribe and pharmacists refill. I don’t do refills, pharmacists do. I diagnose and treat diseases and conditions–pharmacists don’t. I try very hard to keep the line between pharmacists and me visible. Thousands of my colleagues mislead patients about refills. I apologize for them.
Every medication that I prescribe is limited by law to be controlled by physicians based on interactions with patients. As social media is further developed, a lot may change, including the evaluation and treatment of rashes. YouTube like emails may eventually suffice for some visits for chronic diseases, including quick followups on new prescriptions
Very good explanation. Thanks. Your approach sounds much like my Family Physician’s. When he writes a prescription, the “number of refills” box allows enough to last until he wants to see me again; after that, I have to go in for another appointment.
Sorry about the sloppy semantics. I was thinking that doctors write prescriptions; pharmacists fill prescriptions; patients have prescriptions filled at the pharmacy. Patients can ask the pharmacist for a refill, and the pharmacy will contact the doctor’s office when the patient needs a refill. BUT it gets confusing when patients need more of a medicine they’ve already been taking, so the doctor writes a new prescription for the patient to continue taking that medicine.
I guess I’m not exactly clear on the proper terminology. I’d used “renew” since it seems weird to get a new prescription for something that isn’t new. Reading back through, I realized that I sometimes used “refill” when that wasn’t really what I meant, so I fixed it. Is “renew” the right terminology, or is there a better way to say it?
And this post is why I am sooooo for umbrella doctor care. Of course you are frustrated. We are like a pin ball machine with docs sending us hither and nye and we really have no control over this. I wish more the anything docs would band together under one location with all specialties housed within. This way we would truly have a team of docs and the burden would fall more on them, rather then us to get it done and done right. This isn’t a post against you doctor but surely one for medical reform on how things are done in the US. No wonder our costs have escalated so high. Hmmmmm…..common sense to me but who am I but a patient thrown into this helter skelter of our current system. So sorry you are going through this. And don’t doctors realize that every single additional specialist referral ramps up our out of pocket costs?
That’s one reason I like my Family Physician. I first saw him about this in February, and he wanted to try a couple other things to avoid sending me to a dermatologist unless it was really necessary. I appreciate that (unlike my rheumatologist whose first response to just about everything seems to be that I should see another specialist)
Sorry, I wasn’t clear on one of my policies. We respond to our patients with health care. We NEVER respond to faxes from pharmacists. We have no relationship with them. They are not our patient. We pile up faxes from pharmacists on a pile. If our patients want to receive treatment from us they are free to call for an appointment or have regularly scheduled appointments for their chronic diseases. I don’t respond to pharmacists. It’s not just because they sell cigarettes in their pharmacies. They are not my patient.
It’s obvious from your blog that you care about your patients and work at doing what’s best for them. Like you, my Family Physician doesn’t do refills without an office visit. OTOH, my rheumatologist has signs up telling patients not to phone but just have the pharmacy send a fax. It doesnt’ matter to me what the policy is, as long as I know what’s expected of me.
I’ve been tired of doc visits for me and members of my family. Needing to make an appt just to get refills drives up medical costs greatly. Not saying one shouldn’t be monitored, but come on. I guess if you’re not stable you should have visits and not just blood tests, but for stable….
I’m getting slowly worse but still am putting things off. Who’s got money for endless visits? A lot of RA’ers, thirty percent, wind up putting of visits with primary docs b/c they are averaging almost one visit a month to other specialists. This is the one case where I would advocate going to a Rheumy that also practices general med. The two I’ve met though turned me off. Not good with anything but the most mild of rheumatic cases or the least complicated of the chronic condition patients.
I hear you on the cost of endless visits. At $10 my copay wasn’t a big deal. Then it climbed to $20 which was managable, but adds up to a significant amount of money when you have 23 doctor’s appointments in one year. Next it went to $30 and I found myself postponing appointments due to the cost. Now it’s gone up to $35 and I find myself very reluctant to make any appointments.
When I really disliked my first rheumy, I asked my FP if he’d treat my RA. He did for a while (somewhat reluctantly). He’s not comfortable prescribing some of the stronger meds, though, so when it became obvious that I needed more than hcq/ssz, he found me a new rheum.
Slowly worse is not good. It’s better than quickly worse, but still not the best situation. Best of luck finding good treatment.
That being said I wish my academic rheumy would do GP too…
Or some, related GP, but where do you draw the line then. Medical care in this country is a fricking mess no matter which side you look at it from.
My preference is a family physician who does ob/gyn (not all do), so that I have one doctor providing most of my care. I’m okay with him sending me to specialists when needed, but that seems to be much less frequently than internal medicine docs refer out.
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