What are the generally accepted practices that physicians follow for patients who are on prescription drugs for a long time and whose pharmacies call in refills? Is there a common policy to have a certain amount of contact with patients over time, to be sure the prescription is still appropriate? My wife’s doctor prescribed powerful addicting tranquilizers for her many years ago, and just kept refilling them, even though he had no contact with her for over 20 years. Now that she’s trying to break the addiction - with the help of several specialists - I’d like to know how much responsibility her original doc had in the development of her condition. What do docs typically do when those refill orders for all their patients pour in from all the pharmacies? thanks, dopers. xo C.
Sounds like your wife’s doc could (rightly) get into trouble over that one. The standard of care is to stay in contact with the patient, take appropriate histories and do appropriate physical exams and lab tests at regular intervals, if continuing medication is required. That could be on a yearly basis for people with straight-forward well controlled conditions who are knowledgeable about their illnesses. But if one is prescribing controlled substances on a chronic basis, the prescribing doc should be monitoring the patient a minimum of every 6 months, and preferably every 3 months. That generally means a face-to-face visit with examination.
QtM, MD
To elaborate on your question: When I got refill requests from patients whom I hadn’t seen in what I considered too long a time for their condition, I’d give enough meds to last them until they could get in to see me. If they refused to come in, I’d inform them I couldn’t refill the meds for them anymore.
These days I just have my patients frog-marched to my office by security staff when I want to have a little “chat”! 
(Yes, I’m being facetious)
Sounds like an irresponsible physician.
Some refill narcotics or orverprescribe same with no concern. I had an Rx for 100 powerfull pain reliever caps. Got 10, took 3 or 4, disposed of balance down the tube and didn’t get more. I guess the Dr. didn’t want to be bothered.
In most cases the Dr.s nurse calls in refills. No more that two years before an examination and new Rx is frequently the policy.
There is some indication that the Feds. have an interest it the topic!
Thank you. Are the guidelines you mention actually based on statute? Or are these sop’s that one learns about in med school?
Here in Minnesota, we have had at least a couple veterinarian who had their license suspended because they prescribed pain-killers for dogs that they had not examined.
I’d hope that the restrictions on medical doctors are at least as strict!
What about for non-narcotic drugs. I’ve had the same prescription for Albuterol for well over 10 years. I use it here and there throughout the year, but usually about twice a year for about a month while I have a cold I use it very regularly (I have viral induced asthma). Anyways, I usually need a refill on it between once and twice a year. Normally when I call the pharmacy for a refill (even though the srcipt says no refils) they call the doctor, I go to pick it up and they tell me the doc wants me to make an appointment. I never do. The reason I never do is because several refills ago the pharmacy said he would not refill the prescription without a visit. Okay, I called, got myself in, paid the co-pay, wait in the office, he finally comes in. “So what can I do for you?” I told him that I need a refill on my inhaler that I’ve been using for the past 10 years. He said okay and handed me a script. Great, so I had to take half a day off work, drive across town and pay the co-pay. Same thing happened when I need a refil on imitrex (more understandable though, so we won’t get into that). I really do understand where he’s coming from, but I also get the feeling he’s trying to collect on an office visit. At the very least you’d think he’d listen to my lungs, ask me if it’s getting worse, SOMETHING, ANYTHING, don’t just hand me the script and make me feel like an idiot. I do plan to change docs soon, I never really have liked him.
The doctor I go to won’t let me get more than three months without a visit. and these are meds I will be taking for the rest of my life.
Spelling and grammer subject to change with out notice.
Joey P, that visit would have been the perfect opportunity for the doc to do an updated assessment on your asthma, make sure you both were current on your understandings of the degree and severity of your condition, the propriety of your treatment plan, and made a plan for long-term monitoring. I would consider that to be the standard of care, and if any of the docs I supervise had done what your doc did, I’d have given him “job instruction”. :mad:
I’ve had a prescription for meds to deal with arthritis, allergies, and so on, which my doctor’s office refills after a phone call. However, if it’s been a while – like a year – since I’ve been there, she will tell the pharmacist to give one refill and that I should schedule an office visit.
My husband was on some blood pressure & high cholesterol meds prescribed by a cardiologist. At one point he asked for one too many refills without coming in for a checkup, and she simply said, “This man is not my patient. I haven’t seen him in over a year.” Good thing, too. When he did go get the required re-check, she determined that a different med would be better for his current condition.
I agree that the MD who continually re-prescribed Mrs. CC’s meds without seeing her was unprofessional and unethical.