Recent history: I have discovered that 5mg of Ambien taken with 3mg of Melatonin and 530mg of Valerian Root helps me fall asleep much faster than any other sleep medication I’ve tried. I have never had odd behaviors while on Ambien. It just makes me sleepy. I have been taking this combination of OTC and prescription dosages for over two months with only one sleepless night so far (anxiety over possibly losing my job; job is now safe).
The last time I spoke to my doctor about my sleep problems, she said she would give me one refill of Ambien and then nothing more until I got my annual Well Woman exam at her clinic. I should add that I’m 42, and in excellent reproductive health. It feels to me like the doctor is holding my Ambien hostage so I’ll be a good little patient and submit to the speculum. I already have a gynecologist in the next town over who I’m seeing in August. I was seeing the first doctor solely for regular physicals and the sleep issue.
All I want is reliable access to 5mg of Ambien a night, not even every night, but when I need it most. BTW I have no history of addiction or drug problems of any kind, so I don’t think that’s the issue here. I just want to freakin’ sleep like a halfway normal person and not have to “earn” this medicine that helps. 40+ years of insomnia…I’d say I’ve paid my dues.
So is my situation a common one at all? What’s the best way to respond? I’m not even sure just how ethical her request is, but for now I’m staying neutral and looking for advice. Thanks for any wisdom you have to impart.
Guys, did you read the OP? The doctor is withholding sleep medication until the OP gets a GYN exam. That has nothing whatsoever to do with monitoring usage of sleep aids.
Yes, I read the OP. Some women get their annual physical by their GYNs. If that’s the doc prescribing the Rx, then that’s the doc responsible for monitoring its usage. She can get the Rx switched to a general practitioner or internist if she wants and avoid a gyn exam all together. This is what doctors do- they don’t keep writing refills year after year without checking in.
I’d tell her you have your own gyno, and that you’re seeing her/him in for your annual in August. Say you’re happy to come in for a regular Dr. visit re: the ambien, or some sort of physical. . . but your insurance company only pays for one annual a year, and you’d like it with your own gyno.
I have had my doc want me to come in for a check-- for the issue for which the medication in prescribed. I’ve never had one demand I get a gynecological exam for non gynecological medications. They shouldn’t be related.
ETA: BTW, If you’re over thirty, and your last 3 paps were normal, the guidelines are every 3 years now.
The doc isn’t holding the meds hostage, she gave the OP two months worth and said she could have a new script as soon as she comes in. If the OP ran out because she didn’t find some time in the last 60 days to make an appointment for calling the docs bluff that’s her own fault.
I learned this the hard way as well with my inhalers.
This is VERY common.
OTOH, one of the reasons I switched from my last doc is because the last time I needed a refill on my inhaler he said he wanted to see me first. Fair enough, I haven’t been in for a few years. I made an appointment, took half a day off work, sat in the waiting room, got called back, waited some more, the doc showed up and said “So, what can I do for you?” I told him I needed a refill on my Albuterol but he said that he wanted to see me first. He wrote the script, handed to me and that was it. That really bugged me. Didn’t ask any questions, didn’t listen to my chest, nothing. I mean, even if we assume he wasn’t just doing for the money, you’d think he’d want to put something in his chart that said my lungs sounded clear or that I wasn’t coughing etc.
Also, WRT to the OP. The time before that, when I had to call for a refill, they told me that I would need to stop in before I could get another one and they kept that promise.
Okay, I’ve re-read the OP. My suggestion, if I’m reading everything correctly. Would you be willing to use your normal gyno as your GP (which is what I believe you are seeing the ambien doc for)? If you are, call your normal gyno, tell them you’d like to set up a well visit to coincide with your upcoming visit (assuming this is possible). If this works for them, you’d be coming on as a new patient. Since you’ve been with them for a while, upon receiving your file from your other doc, they may be willing to write you enough ambien to get you to your upcoming well visit/well woman visit.
If you want to leave well enough alone, I would just call them back and explain to them that you already have a gyno that you see on a regular basis and that you just see this doc as a GP. If you’ve already had a well visit this year let them know, if you haven’t you could schedule it now, but see if, upon scheduling it, they’ll refill the ambien to tide you over until then. It’s entirely possible that, being a gyno office, the appointment manager just noticed that you hadn’t had a well woman visit and tried to schedule you for that and it’s nothing more then a mix up. They probably don’t have many women that use the doctor as a GP only so it created some confusion.
Her request, very ethical. As a doctor, she needs to monitor you - as Alice said, if it didn’t require monitoring, it would be OTC. If she isn’t monitoring you and phoning in scripts, she is abusing her license and could potentially get into trouble.
If she really insists that you have your exam at a facility in which she has a financial interest, then yes, that seems unethical.
If she is willing to accept documentation from an outside practitioner … well, I guess I personally would be slightly annoyed in your shoes, but I do see how it is within bounds and is presumably being done with your best interests at heart.
Again, did you read the OP? She won’t get a scrip for a SLEEP AID until she gets a GYNECOLOGICAL exam. At that particular clinic. That sounds a bit off the wall to me. I’m agreeing with those saying to see if this doc will accept that you’re seeing another gyno; if not, look elsewhere.
Very very common. When working in pharmacy, I see a lot of times a doctor will call in a refill for a medication, and put a note on it that “no more refills until seen for doctor visit”. If it has been awhile since you saw the doctor last, they will want to see you to monitor for the medication…
But, also to add, since this is an GYN prescribing a sleep aid (actually very common, a lot of women treat their OB/GYN as their PCP), the DEA has been cracking down on prescribers that prescribe a controlled substance (which Ambien is, Schedule IV) without having a “doctor/patient relationship”, and have been revoking doctors DEA licenses. What is considered a valid “doctor/patient relationship” isn’t set in stone, but is a lot of times considered seeing the patient at least once within a year.
So… If you have an appointment set up already, ask them to call in enough to last till the appointment, most doctor offices will do this. If you are going to a new doctor, have the new doctor call in the script before the appointment.
Also, be aware… This is a controlled substance you are talking about, so your pharmacy won’t be able to loan you any, no matter how much you ask or beg. Work it out with your doctor before you run out.
To be clear: In order for a doctor to prescribe medication, they have to have an exam on record within the previous 12 months. Prescribing medication without an exam on record within the previous 12 months is grounds for them to lose their license to practice medicine, let alone their DEA license for controlled substances.
If you are using your GYN as your primary physician, and that GYN is practicing through a Women’s Clinic, then of course a yearly GYN exam will go along with a regular wellness checkup. Or perhaps there’s some other medication besides Ambien that the OP is taking, that would also require a yearly PAP rather than a 3-year, too.
This is even harder for dog/cat owners to understand! We recently had someone call wanting a refill of a prescription for a dog we hadn’t seen in four years. It was “just an ear medication” but the very same restrictions apply for DVMs.
OP checking in very quickly before going to work. Thank you everyone who took the time to read and respond. I have a much better understanding of what’s going on now.
A bit more explanation to help clarify my initial uncertainty:
I moved to this area last year and found an Internist/GYN near my first job, got the annual physical/well woman exam in April '10. I also did a sleep study with a sleep specialist, who found that I did have insomnia but nothing physically wrong. Changed jobs and insurance plans in August '10. In Feb '11 I began having a choking feeling in my throat and worsened insomnia. I had several visits with this new GP who is close to my new job during late winter/early spring. GP gave me the Ambien and also sent me to an ENT doc to get my thyroid checked. Then my insurance co. began refusing to pay for my sleep-problem-related visits. I didn’t know if it was a billing issue with the new GP’s office, or BC/BS, but it threw a huge monkey wrench into the works. The GP’s billing people…weren’t helpful. Claimed to know nothing and refused to lift a finger to investigate. So JoeyP is right, I brought this on myself due to a lack of time, but not a lack of effort (or money!).
Long, dumb story short: I would much rather go to this new GYN who is also close to work. I think the GP will let me send in physical results and labwork from elsewhere so she can make a better judgment call on the Ambien. If she’s not willing to do that, I’ll speak to the GYN and failing that, the internist from last year who’s a bazillion miles away from work.
Again, thank you so much, everyone, and hope I didn’t come off too much like someone who’s avoiding doing “the right thing” to get the sleep aid. I guess I still didn’t appreciate just how controlled Ambien is - gosh, all it does is make me juuust drowsy enough to snooze! But nobody gets to be a special case in this matter. grumble grumble
She needs a well woman exam. That’s a physical that involves a gyn exam. My last two well woman exams didn’t even involve a speculum (without a suspect pap smear, I guess I only need them every three years).
Women have other parts on them than their hoo has. If she wants a gyn exam from a gyn, she can get a general physical from her general physician and have the gyn records faxed. The GP may still want to do his own gyn exam (but probably not bother with a pap) or maybe not. Or she can ask her gyn to prescribe Ambian (mine referred me to a GP when those sorts of things became more common than 'birth control refills, infertility, and pregnancy - he was willing to treat insommia as a one time thing, but chronic complaints not involving my female bits were not up his alley), or she can drop the gyn and have her pap done by a GP.
It sounds like she recognizes this in her last post.
It’s common. Heck, even our veterinarian refused to re-prescribe my partner’s dog his flea meds until he came in to get his yearly doggy physical. The time span between his last round of blood work and check-up had exceeded some time limit and they like to be sure they have current data before renewing any medication. I don’t know their limit on “current.” The dog is also on a long-term medication. The physical was required to make sure that he isn’t getting any kind of liver damage or other issues from those meds that might cause problems with the flea meds.
I don’t know about a “Well Woman” exam, but my annual physical by my family doctor includes the gyn exam and a general work-up to make sure I haven’t developed any new health issues. The last time I had to go on any kind of medication for an extended period of time, I had to get a physical.