Though I’m surprised at the doctor insisting on the GYN exam being part of the process - that’s a bit odd. My primary care doc has certainly insisted on seeing me before redoing scrips - that just makes sense - but knows I see a Gyn in another practice and has zero problem with it.
Something interesting about Ambien scrips: It’s a Schedule IV controlled substance in the US, and therefore scrips expire in 6 months. Ditto Sonata. So the doc might well insist on seeing you every 6ish months (though as schedule iv, apparently they can phone / fax in the scrips vs hardcopy which is required for some higher-schedule drugs).
Just imagine the malpractice suit a person could file against a doctor who prescribed them medication for a couple years without doing a checkup–and then has a bad reaction due to some condition the doctor would have picked up in a checkup. Too much of medicine is now CYA for the doctors–I can’t blame the doctors but it sucks to have the extra cost passed to us.
I had a doctor refuse to give me birth control until I got my lady exam. Fast forward a little over a year after I graduated but wasn’t working so didn’t have insurance, I went to Planned Parenthood and got birth control without all the fuss. They made sure I wasn’t knocked up, then sent me on my way.
Hell, my doc’s office is even more uptight…their rule is no refills if the doc hasn’t seen you in the past 3 months. I recently encountered this when I ran out of refills on my levothyroxine, a medication I’ve been taking for more than 25 years.
As has already been noted by others:
Docs are obliged by law to not prescribe any med for over 12 months at a time, and follow-up visits are required, often by law, nearly always by regulation by the Medical Examining Board, and more and more often by health care systems, that an exam must occur yearly before a chronic medication is refilled, other than in emergency circumstances.
This is not the whim of an unreasonable physician. It makes for good patient care, too.
Well, to be fair, if you are using your gyn as a primary care doc, they are going to do what they specialize in, after all. Although all we know was that they wanted a “well woman” visit. I’m not sure it was confirmed that an internal exam was required.
My doctor’s office also has this policy. Annoyingly, though, they didn’t TELL me that the reason the doctor wouldn’t approve the refills was because I hadn’t come in in the last quarter. If I called up the doctor’s office and had a hissy fit, then I’d get my refill approved without having to make an appointment…so I didn’t know that the doc wanted to see me every 3 months. How the hell was I supposed to know this if nobody told me? :mad: :mad: :mad:
Lynn, yes, exactly! Mama Zappa mentioned a six-month rule for Ambien, but my doctors have been even more restrictive than that. The sleep specialist gave me only a two month prescription for it last year, and it took several phone calls after the pills ran out to find out that I was required to come back for a visit every 2-3 months (never did get a straight answer about the number of months). It appears to be the same thing with the GP I mentioned in my OP. And as the insurance company was charging me $150 per insomnia-related visit to the GP, I just couldn’t afford to keep going back.
After thinking about this some more, I believe the reason the GP wanted me to come back for the GYN exam was so she could do the insomnia consultation at the same time. But because their billing department is so screwy, I’m not sure that I wouldn’t have been hit with another big charge anyway. Repeat every three months for the rest of my life. Sigh. There has got to be a better way to do this.
Well, you could have a talk to the doc about the scheduling and billing issues and how they’re making compliance with his/her directives difficult.
Recently, my GP wanted to see me every three months, instead of once a year. I asked why. He said that I had reported more asthma symptoms and he wanted closer follow ups to determine if it was the start of something serious, or just a temporary increase due to cold air/stress/other transient problem. So that’s what I did. Last check up he said I seemed to be back under proper and consistent control, see you in 8 months. 8 months? Yes, because I needed to get my annuals tests/screenings/etc done by end of November both for good practice and to keep the insurance company happy. OK… but that’s September. Yes, but it generally takes 6 weeks to do all the subsequent scheduling of things like blood testing (which, due to insurance idiocy, I can’t have done at his office, I have to go to a clinic across town) and mammogram and so forth. Oh, right. See you in September, doc.
Then again, my doc seems a bit more aware of insurance/Medicaid/Medicare insanity than most. Can’t really fault him, the vast majority of his patient load are poor people with little or no insurance, crazy rules to live under, often intermittently employed when working at all, and often with chronic conditions. I have to deal with the insurance idiots myself, but he’s been very good at communicating. I like to think I have, too. It does make things easier.
My spouse has more issues with Rx’s running out than I do - and given he has diabetes (along with a couple other less immediately dire problems) that’s a serious issue. Yes, sometimes he winds up having to make an extra appointment in order to take care of these things - as it happens, our insurance doesn’t charge him for the office visits so we are VERY lucky! (By some miracle, whoever set it up actually understands the concept “preventive care”.) But we’ve had all kinds of craziness with neither the doc nor the pharmacy knowing what Rx’s are covered sometimes, sudden discontinuation of coverage which requires a visit to the doc before an alternative can be prescribed, phone calls to the insurance company, faxes to the pharmacy.
Really, it’s not always the doctor’s fault. If you are going to be taking an Rx for the rest of your life, or at least the foreseeable future, you will run into this. I’d suggest when you see the doc to ask what the rules are for being prescribed Ambien, frequency of follow-up visits, and schedule those visits for before you run out. Yes, it would suck if you have to pay extra for additional visit(s). With some planning maybe you can avoid that.
You’re lucky, My doc does the 3 months thing. And, no, I don’t buy that he’ll get in trouble, as I’m the only person who would tell, and not only has he known me for all but two months of my life, but, if I told on him, I wouldn’t get my medication. And, while it isn’t scheduled, my life is hell without it.
Heck, I’m going to try to bargain this time for six months, if I can get up the nerve. I would love to have your doctor, OP. In fact, if I can get any citations about the requirement being only within the year, I would greatly appreciate it.
IANAD.
Mr. Panda, 'bout a year or so ago, started getting a choking feeling in his throat, particularly when he laid down to sleep, which would also trigger a nagging cough. It wasn’t one of those deep, rib-cracking coughs – it was just cough-y enough to be annoying as hell … which of course screwed with his sleep.
Turns out the symptoms he had are very common side effects of Lisinopril, the hypertension med he was on at the time.
Just throwing it out there, just in case.
As far as your situation, I think it may vary from state to state. When I lived in WV I had to see my shrink every 3 months to get my Adderall script. (“Hi, how are you, are you suicidal? Hearing voices? No? Ok, hereya go, seeya in 3 months.”) I live in another state now and my GP prescribes it and only has to see me once a year.
I love the “MD won’t write scrip” from the thread title.
There’s a memorable section of one of William Burroughs’ books where he talks about how he and fellow addicts value finding “a croaker who’ll write scrip” (in this instance, for opiates like morphine).* This has become a commonly used phrase in our household to refer to docs who readily write for prescription refills in general).
While recognizing the need for patient monitoring, a croaker who’ll write scrip is a valuable find.
*not suggesting that Ambien and morphine are in the same class, of course.
I’m on lisinopril and I’ve had the choking feeling occasionally and I had no idea what it was!
Thank you!
Yeah, Lisinopril and the other “pril” meds (ACE, or Angiotensin converting enzyme inhibitors) do cause a histamine buildup, so a dry cough, head congestion, scratchy throat and other symptoms of too much mast cell degranulation can occur.
If one really needs the effect of an ACE inhibitor without the messy side-effects, an Angiotensin receptor blocker (ARB) can do about the same job without histamine buildup.
ARBs are more expensive, though. At least at present.
No, you’re not the only person who would tell. A lawyer would tell if something went wrong. Let’s say that one of the side effects of taking Ambien long term is, for example, esophageal cancer. Now, because of this, the doctor may want to see you at least once a year (at the same time as your well visit) to ask you some questions, look at your throat and teeth etc and keep an eye on this. If he keeps an eye on this and notices symptoms of it and deals with it, he’s in the clear. However, if he just lets you take it for years and years and years without ever checking in on you and you end up developing this cancer, he could face a malpractice suit.
Similarly, I use an inhaler. Once a year I have to stop in and see my doc, I always figure that want to make sure that I’m still using it for asthma and that I’m not trying to self treat for something like bronchitis or lung cancer with Albuterol.
Another thing, do doctors ever have their prescribing records audited? Is there any federal agency (FDA?) that might randomly (however unlikely) look at the OP’s record and fine the doctor for prescribing Ambien for several years without seeing the patient?
Also, you have to remember, just because YOU are taking Ambien correctly, doesn’t mean other people are. And because other people aren’t, you still have to abide by the rules. It’s like saying to a cop when you get pulled over “I know the speed limit is 55, but I can drive safely at 70, really.” I’m sure you can, but we all have to obey the rules.
Hell, I see my GP at least once a year, often more (annual physicals, plus whatever other things pop up during the year, and there’s usually at least one round of asthma flare-up or bronchitis or something else). Once, maybe 3 years ago, when I was complaining of chronic insomnia (which I’ve had on and off for maybe 8 years), he prescribed me 20 tabs of Ambien, with instructions only to take one if I was desperate and hadn’t slept properly in 2 - 3 days. I have no history of addiction of any kind, no relevant chronic health issues except mild intermittent asthma, and heck, I didn’t even take most of the painkillers I was prescribed after surgery because I don’t like the feeling of not controlling what my brain is doing.
It took me over a year to use those 20 tabs, and when I mentioned insomnia again at my most recent physical, he said he was really reluctant to prescribe anything, and I should give melatonin another shot (it works for me sometimes, but not always). Sigh - I don’t like taking Ambien either - it says to leave at least 7 hours for sleep, but for me it’s really more like 10 - 11 - but hey, people need sleep!
My gyno, OTOH, when I talked to her about it, wondering if it was perhaps hormonal (she thought probably not once I described my pattern), was perfectly willing to prescribe me Xanax. (I didn’t take her up on it, but she did mention that maybe it would help to take melatonin every night instead of just when I couldn’t sleep, which has proven to be the case for me.)
So yeah, as others have already stated, it’s not weird at all for a doctor to want to see you before renewing a prescription, particularly for a controlled substance.
Ambien seems to really spook a lot of doctors. I’ve gotten the same lecture on Ambien along (and also don’t like taking it - for me its the sleep of the damned - better than no sleep at all, but the hangover sucks).
(For me, a combination of melatonin, valarian, and benedryl works as well as Ambien and its all Otc. Don’t take valarian along with any antidepressants without talking to your doctor)
Ambien (Zolpidem) has a potential for addiction, abuse and resale.
An annual visit to check your mental health, sleep issues and BP before giving you the script is entirely reasonable.
Otherwise your doc has no way of knowing whether:
- You’re stockpiling meds for an overdose because you’re depressed.
2)You’re selling your meds for profit. - You keep taking the meds but have horrible side effects/ they aren’t working and you should be on something else.
- You have developed an addiction and are buying extra meds as well as the prescribed ones.
- You would like to stop the meds and would like support and advice on how to do this.
You can decline a pelvic examination if yours isn’t due, but your doc is trying to be a responsible and ethical prescriber- not a big meanie.
I have patients who are required to see a GP on a weekly or fortnightly basis for their sleepers (because we’re pretty sure they have addiction issues or are selling their meds). It could be worse.
This is not true here in the US. As far as I know, every state has a controlled substance database. They can run your name through and see everything you’ve filled in a specified amount of time, what pharmacy filled the script, what doctor wrote the script, the date, the number of pills dispensed, etc.
People who see doctors for chronic pain issues generally have to promise to only use 1 pharmacy and to NOT get meds from other places* … and a lot of docs will do spot checks. If you’re busted, you’re discharged from the practice.
*There are some exceptions to this. Some pain doctors - especially where I live - don’t require you to sign a contact to get meds from only them. Other docs are ok with their patients getting meds from other docs under certain circumstances. My mom saw an MD for her back pain and had a contract with him, but he was ok with her getting painkillers at the ER whenever she had one of her dozens of kidney stones.