Fulfilling

“When was the last time you saw a doctor?”

“Three years ago.” 

I looked at his blood pressure reading and cringed.

“How long have you been out of your blood pressure medication, then?”

“Out? I haven’t been out. My old doctor just kept refilling it.”

Our clinic recently instituted a protocol for allowing staff to authorize patient medication refills. It is a system wide thing, across our healthcare organization, so it is being utilized in every practice. Supposedly it is to free physicians up for more important things, like seeing patients, generating revenue. Isn’t that nice.

I hate it, though. 

I hate the whole idea.

Sure, I have trust issues. That is the first problem: Trusting that staff is always doing the right thing is hard for me in this case because these are drugs. Drugs can kill people if used wrong. Doing my own refills gives me oversight. Then, there is the self importance issue. If a medical assistant can refill meds, then what does my degree really mean? Less then it did before. And most importantly, if I don’t have time to handle simple refills for my patients, then am I too busy? 

I enjoy keeping tabs on my patients, doing their refills. Maybe I am crazy? I really do enjoy it. Taking refills away from me makes me feel less useful, less fulfilled. But I am going to try it. I’ll give it a go for a bit and see…. I don’t want to be labeled an old fogey. Yet. 

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100 thoughts on “Fulfilling

  1. I’m sorry, but I think it is absolutely horrible to have someone OTHER THAN a doctor authorize refills! They aren’t licensed or educated for that…they’d be docs themselves if they were. My health is far too important to allow someone unqualified to say “Oh yea, refill that” or “no, don’t refill this one”. Honestly, isn’t that just practicing without a license when you get to the bare bones of it? No thank you. Honestly, I am a bit of a rabble-rouser and would probably turn the practice into the board that administers docs and have them investigated.

    Liked by 1 person

    • This is the trend across the medical field. So long as there is a written protocol it is completely legal and the medical boards don’t care. Many patients probably don’t realize that their physician’s offices are already doing this as it is not advertised. I have been a hold out to this point but was sort of forced into it now. We will see.

      Liked by 1 person

      • This is a fairly new protocol right ? Then you can’t be labeled an old fogey for disagreeing with foolishness still in its infancy..
        We have an opioid epidemic now.. Can you forsee how much worse it could get with staff refilling scripts ?
        What does your degree mean ? I would turn that question to the so called efficiency experts.. They are trying to redefine a medical degree AND redefine the education, wisdom from experience, insight from Dr/patient relationship, needed to make the decision to refill/discontinue, run more tests, change drug, ect..
        What about blood thinners ? Are the medical assistants going to schedule the periodic testing and make dosage changes accordingly too ?????? Diabetes meds same thing ? The lines are being redefined.. It is not for the sake of dr or patient.. It comes down to what efficiency means to business, the bottom line, to bolster the profit margin, ironically, at any “cost”..
        No Doctor, you are correct and your commitment to your patients is caught in the crosshairs of business
        greed-steriods..
        Too bad we have no way to cut them off that drug.. πŸ˜’

        Liked by 1 person

  2. And you’ve given the perfect example as to why this is a potentially dangerous issue. Medications that work for a while may end up NOT working down the line- this guy has been taking his pills and totally unaware that his blood pressure is still jacked up. Bodies change, they develop tolerances, they get better and worse, and that’s why we should be relying on YOU, our medical professional with the extensive education in these sorts of things, to call those shots and keep an eye on us down the line. Hopefully your next visit with this patient comes sooner than 3 years from now 😦

    Liked by 2 people

    • Exactly. I hear this sort of thing fairly often from new patients. And the problem is that you don’t know the system isn’t working until much farther down the line, after potential harm has already taken place.

      Liked by 1 person

  3. I enjoy taking and performing my own refills. I do not allow staff to do this. Yes, my hours are longer but I make notes as I go; keeps me closer to the patients. I agree with your 100% on this and I am an old fogey. My father and uncle engaged in this practice; I honor them by doing so too.

    Liked by 4 people

  4. I’ve been living under the shadows
    Of Dr this past year
    I had to accept a lot
    Where before I denied
    You being a Dr seeing
    Both sides of the fence
    Is admirable,they don’t
    Teach bed side manor
    Great post
    As Sheldon Always

    Liked by 2 people

  5. Hmm… that seems like dangerous territory, allowing any (?) staff member to authorise refills.
    Here in Australia, the professional Pharmacy associations have been pushing to get pharmacists rights to dispense refills for certain medicines (contraceptive pills, statins) without a current prescription IF the patient has previously had the drug dispensed. We must also notify the doctor, which is only fair, really. At least, as pharmacists, we’re trained to determine when a referral is required. I hope your staff have similar training, or at least have a protocol to guide them…?

    Liked by 1 person

  6. With so few words you said everything that is important between anyone and their doctor. All of the paperwork and insurance frustrations makes us forget that human connection that meeting with a doctor face to face provides. Thank you. I’ll be sharing this.

    Liked by 1 person

  7. I suppose it depends on the drug and the number and frequency of the refills. Just saying that, implies that some oversight is needed. It doesn’t always have to be a visit or even a phone conversation, but in my opinion, I want my doctor to at least give the “okay” to the staff member.

    Liked by 1 person

  8. I’m my husband’s practice manager. He has strict protocols. If he puts someone on a BP med he wants to check to see that it’s working properly. I do have authority to refill RX’s but am very cautious. As for the controlled substances, he insists on a visit within a six month period–no refills of Alprazalam without that. We used to keep a log before EMR’s and that was ridiculous. Today it is a lot more efficient. Still, if the patient hasn’t been here in a while, I’ll ask the doctor before any meds are refilled. N.

    Liked by 1 person

  9. Reminds me of working in all kinds of places. We now live in an age of technology and gadgets. Almost everything, almost every effort is replaceable.

    Thing is, tell a device or less experienced person to make the rounds and do some check ups and they have no clue of what to do. Experience taught me that people who do their own rounds and check ups get more done.

    Efficiency is good. Knowing what is actually going on is better…

    Liked by 1 person

  10. If you have a health problem requiring medication, I would feel it important enough that the doctor monitors it. When you need a refill that would be a good time to see how the medication is working or if there needs to be changes. It’s just good follow up care.
    Leslie

    Liked by 2 people

  11. I’m probably at risk of saying something stupid here but …. isn’t there a protocol for allowing the doctor to specify the maximum number of authorized refills before the patient needs to be reassessed? Depending on the drug it could range from 0 to whatever.
    That protocol works well here between doctor and pharmacist … I think a similar process would work just as well between doctor and medical staff.

    Liked by 1 person

    • It relies on staff checking last appointment date, making sure certain numbers are within certain ranges, and paying attention to the number of refills. It is too new here to know if it is going to work well. I have never done it before. Time will tell.

      Liked by 1 person

  12. That sounds a bit dodgy to me, especially as it had been such a long time before a doctor had been overseeing his meds.I don’t think you are an old fogey at all, rather a caring doctor who wants to do the best for her patients! You have trained long and hard to earn your degree and the respect of your pastients, you do not want the chance of it being messed up by someone untrained.

    Liked by 1 person

  13. This seems to be a flaw in the system to just automatically refill meds without monitoring the patient. You brought up the example of your patient coming in with a elevated blood pressure I assume because you said you cringed and they had been getting their meds automatically refilled for 3 years. Do you think people should come at least once a year to a check up? I know it is hard to buck the system which seems focused more on cost that health these days.

    Liked by 1 person

  14. I want my doctor to know what I am doing with my meds. so I do not have an issue if the protocol includes a check by the MD to see if they have been in within six months and that the drug is not a narcotic or other abused drug. But…then how would a non-clinical have that knowledge. If a NP, PA or even BSN was doing the refills, I would not have a issue follow the above rule. Med Assistant….yes I have a problem with that.

    Liked by 1 person

  15. Well Victo, I rather hate to admit this but I just encountered this very thing myself. Last year my BP meds were cut to 1/2 dose and then I was told that I could likely stop them as things had stabilized, looked good, I had lost weight… etc. Sort of a trial run if I was willing to monitor my own pressures. The last script ran until March or April so I had just kept taking the half dose and was planning to start the ‘trial’ of no meds when the refills hit zero. My pharmacy alerted me last week that I had a refill waiting, and the only medication they fill for me is Lisinopril. Apparently when the RX ran out, they called my doctor, who I can now no longer see due to divorce healthcare changes and requested the refill. Funny thing, when I checked the script on the new bottle, which I did pick up btw, my doc hadn’t technically filled it. It was an MA whose name was on the bottle…

    Liked by 1 person

  16. I have to say we had that option for a time to just go in a pick up the repeat script without seeing our Dr. and now, we don’t again. I really liked it when we had the option to just pick up the repeat papers without having to see the Dr. Really more for convenience sake not having a long wait time when not feeling well. If it’s narcotics I needed, I always had to see my Dr. for the repeats that is still closely followed by my Dr.
    I see where you’re coming from though. Here Dr.’s are too busy. They will book three people in one 15 min. time slot. When I see my Internist. My wait is often 4-5 hours.

    Liked by 1 person

      • I couldn’t agree more. It’s frustrating that’s for sure. I don’t mind waiting when the Dr. takes time with his patients but I don’t think it’s fair when they book that solid and then the rest of my time is a write off.

        Liked by 1 person

  17. I don’t like this at all. A medical assistant recently gave LM a refill on an *old* prescription, not the current one. (I don’t know if it’s standard to have access to the old ones or just current ones.) That bothered me. We caught it and there wouldn’t have been any disastrous consequences with this one anyway, but there could have been.

    Liked by 2 people

    • This EHR does that. If a pharmacy requests refills an old dose or med it is not readily apparent that it was old. It may say, “source prescription discontinued but it is in tiny print and of you hit the refill authorization button there is no hard stop that asks you what you are doing. It IS a bit scary how easily errors can happen.

      Liked by 2 people

  18. My preference would be for you to fill the meds, period – end of story. Harsh? Maybe, but my sister was nearly killed by a lethal combination of prescribed meds for her Lupus. For me, having the Dr. fill out the prescription gives a strong sense of comfort that I’m being properly watched over.

    Liked by 2 people

  19. I would think your staff is of two camps on this. I’d bet there are some zealous types who secretly think they are “almost” doctors because they’ve been around for a while, and so they are wanting to be able to do this. And I’d think there’s the other camp that, for the most part, are cringing at not wanting the responsibilityβ€”not the extra work, the responsibility, for the reasons you mentioned.

    I do have a story for the other side of it. Perhaps you recall I mentioned that the last time I was on antidepressants I had to stop cold turkey because of a doctor, who if he didn’t break the Hippocratic oath surely bent it to hell. As you know, quitting a high-normal dose of antidepressants abruptly probably ain’t recommended. I was uninsured and so could only afford the sliding fee clinic. Their prescribing psychiatrist was only in the office one day a week for a very limited time. It wasn’t a problem until I started a new job and ran out of my prescription at the same time. There was a mandatory 6 or 8 week training period and if you missed *one* day, even partially, unless hell just froze over you lost the job. I called to get a refill, was told that the doctor *had* to see me to refill it (no he didn’t, I later checked, it was merely his prerogative). I explained that I couldn’t do it for those-many weeks. Too bad. I explained that I could not come in, I was running out, and when I ran out I’d have to stop cold turkey. Too bad. There’s control freak and then there’s control freak.

    Liked by 1 person

  20. Medical centers are moving towards splitting responsibilities like this because, there is no money to be made by sending in prescriptions or inputting medical history. They only get money when they are forcing doctors to assembly line patients through their clinics. And when providers are forced to do that patients are left feeling rushed, unheard and afraid to ask questions. It’s a negative feedback loop of BS.

    Liked by 2 people

  21. Pingback: Writing Links 5/15/17 – Where Genres Collide

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