I know of no law but ther are usual and customary practices and, if there was some complication, we’d be leaving ourselves with some exposure if we didn’t follow patients on chronic meds with at least an annual check up. Maybe there are side effects, maybe the med is no longer needed, maybe the dose should be adjusted, maybe other helath issues have occured that make this med no longer a good choice … who knows?
That said, yes call your doc and explain your situation. Many of us are understanding and have made visits no charge once or twice for a long standing patient who is having a financial hard time. It often really is a desire to practice according to what we believe is the correct standard, and not just trying to milk a quick visit charge.
BigT if on Celexa you still can’t leave the house due to disabling anxiety and/or fear, then perhaps the Celexa alone is not what you need. Just sayin’ …
I do get that. Of course I want a doctor to provide the best standard of care. BUT. There also has to be some level of flexibility and communication. I’ve now spoken with two of his nurses and the issue comes across as more of you-will-do-as-I-say or no Clarinex for you! If his nurse(s) had said “We want to make sure there’s no issues we need to be aware of. Has anything changed in your medical history? No? Is the medication working for you? Ok, sounds like everything is fine and we want to make sure you’re doing well” that would have been totally alright by me. But I feel like I was being pressured to come in, punished for not coming in, and then outright mislead. I think my doc is a really nice guy and a good doc. His nurses are pretty mean, frankly, and inflexible. No refill unless you come in. I’ve asked that he call me on Monday, because if I’m going to fire him I want him to know why.
There’s another thing to consider here: liability. Say that you stroke out tomorrow, via some unrelated medical thing. SO wants blood. Gets a lawyer, goes to trial, and the doc gets asked ‘When is the last time you saw patient?" doc:“uh…uh…” Lawyer: "So, do you always prescribe drugs without examining a patient…’ you get the picture. Next thing, the state board of medicine gets in on the act. Doc pays your SO 4 million, then, loses license! So, he could be stretching a point, but, at the same time it is a matter of (some) law.
The OP has a right to be annoyed if he was inaccurately told that it’s the law that he must be seen in the office when he later is informed that it’s “policy”. Jurisdictions differ, but I doubt that most states demand you be evaluated by a doc at no more than yearly intervals in order to get that type of drug prescription renewed.
The part about the mean nurses may reflect a situation where the doc wants to look like the nice guy and so has the nurses lay down the “law” about office visits (whether it’s a means of following up on patients as part of good medical practice, to minimize liability risk, to feed the bottom line or a combination of all three).
I’ve also run into a situation where I was told to come in for a recheck before getting a prescription renewed and I felt it was unnecessary. The last time they just gave up on hassling me and I got a year’s worth of refills.
I was actually more thinking of the antihypertensive case. Clarinex should be otc. That and nasal steroids should be able to get prn refills with maybe the caveat to discuss if cheaper options have been tried again at some point.
Come on. Why do you think the doctor owes you a free ride just because you saw him over a year ago? If you don’t want to pay 50 bucks to the guy who spent years getting a medical education why did you see him in the first place. Just see your GP if he is willing to have you use him or get your claritin or allegra over the counter. I don’t think he owes you eternal service for nothing but heck if you can get it for free why pay for it.
This is one of my pet peeves. “Just have the GP do it” “Ask your GP” etc. Now, first of all let me say that when it comes to allergy meds I tend to be pretty flexible and will refill for at least a year before requiring a visit. However…
If you are on medication that needs monitoring you need to come in and be seen. I understand that you have a $3000 deductible so you don’t want to come in but I have no idea if your diabetes is controlled with the current medication or if you’re about to have a stroke since your blood pressure is too high or too low or if your liver is damaged because of your cholesterol medication and I really need you to come in and let me check you. Not only that but you are taking OTC diet pills or St. John’s wort or other things that interfere with your medication and if I don’t know that I can’t warn you and just because it’s “natural” doesn’t mean it isn’t harmless.
I try to work with you the best I can. If you have no insurance and no money I string out the appointments as infrequently as I can. I make sure that I only do the minimum required blood tests and I let my medical assistants do blood pressure checks instead of scheduling full appointments. This is a lot of work for me that is unpaid. I also need to pay the bills.
While I understand that the specialist charges twice as much for the same length visit and your copay is twice as much, that doesn’t mean that you should just ask me to do his job too. Look at it from my perspective. I went to medical school and spent three years in residency too. The cardiologist wants to see you once a year to check on your heart and the psychiatrist will only fill your medications for three months without a visit so you come to me. Each of these doctors has a 15 minute appointment to address these problems. You would like me in my 15 minute appointment (for which I am paid half as much and get half the copay) to not only do my own work assessing your diabetes, blood pressure, and cholesterol but also to take care of their evaluations also, to monitor their medications which includes taking on any liability for prescribing the medication and any side effects and while you are here you have this vaginal discharge and you don’t want to pay the Gyn copay so will I mind doing an exam, culture, looking at the slides under the microscope etc. Oh, and one more thing, the GI doctor has started charging $10 for each telephone prescription refill so would I please refill all of his medications too.
A lot of my colleagues will flat out refuse ot will ask for additional visits to take care of additional problems but I guess I’m a soft touch. I’d rather get everything done in one visit and save you the copay. However, when I threaten that this is absolutely positively the last time that I can refill your medication without seeing you I do mean it. If you truly cannot afford to see me, there is a free clinic and I will gladly give you the number or I can work out a payment plan. However, just dumping all the work on the overworked underpaid GP simply to save a copay may not be in your best medical interest.
P.S. I really do love my job-otherwise I would be a specialist. Frankly, I can actually do about 90% of what the specialists do. It just sometimes gets to me when the patient goes to a specialist who doesn’t even examine them and then comes back to me for the exact same condition and I spend the time and energy actually evaluating the patient only to be informed that my work valued so much less. Case in point-patient went to a Dermatologist with a rash who looked for a few seconds and told him he had dry skin and gave him a lotion which didn’t work. At my visit I actually examined the patient, did scrapings, examined them under the microscope, diagnosed the parasite and prescribed the correct treatment all without getting paid any more than I would for his routine follow-up visit, which is less than half of what the Dermatologist gets for his 10 second consult.
