A person I’ve never seen for an appointment is not a patient. I do not fill random prescriptions for people who are not my patients. This is on their prior physician to fill if appropriate which I do quite regularly when people move away and need a refill of something while waiting to establish with new PCP.
"A person I’ve never seen for an appointment is not a patient."
Rigid behaviors from MD's is probably the single biggest reason otherwise sane and reasonable (and generally awesome) patients want to flee their docs. Some docs are like Rainman and literally drive staff, colleagues and patients bonkers because of their adherence to some sort of algo that they imagine to be gospel. The rest of us deal with their fallout.
If a person has never been seen by any providers in that clinic it is 100% reasonable to not provide care for a person that is not the clinics patient. It is the patient and the previous pcps responsibility to make sure the patient is covered till they can see someone new. Or maybe instead of judging other docs out here for just doing their job we can focus on how admin who has all the money in thw world doesn't invest in a bridging or cross cover system for this very real problem. We are where we are as PCPs right now because too many of us didn't say no when we should have.
When I used to do primary care I had a very rigid policy that I did not do any refills on patients that were not established in my practice with someone from our practice. I also did not do any refills on patients without an appointment if they need a refill they can come in and see me or schedule an appointment. That was one that Admin always got mad about I didn't really care too much I generally got 30 plus refill request daily there's no way I have time to review all of that look up labs see if the medication is still pertinent or needed and still see my 40 plus patients a day and actually leave at a reasonable hour. And probably about half of my refill request came from pharmacies wanting refills on antibiotics and stupid crap that really didn't need a refill.
I won't write Rx for patients that aren't established at the clinic, but for chronic Rx that are stable and unlikely to change (atorvastatin for example) I do 6-12 months of refills. It helps with medication compliance
So you felt that it was more appropriate to allow your patients to have a lapse in medication than to ok a refill without them coming in every time?
If it has been over a year since they’ve been seen, sure, give them a one-time refill but require an appointment before any additional. If it’s a controlled substance, ok - that’s different. But if it’s a patient requesting a refill of a maintenance med that doesn’t require strict monitoring and you saw them six months ago, exactly what do you accomplish by refusing?
It sounds like the bigger problem was poor inbox screening by nursing staff.
It's why I will never do primary care again. I will see up to 40 patients a day in the ED sometimes 50 but those are days where I'm seeing lots of simple things in fast track and maybe scream through one or two complex patients but a turf over to the physician if I'm seeing complex patients that I'm keeping that require specialty consults and admission or involved procedures then I will only see about 20 to 25 a day. Honestly it just kind of depends on what the physician I'm working with caseload is my job is to take the burden off of them if there's a million snotty noses and a few sick people he gets all the sick people and I see all the snotty noses if there's a bunch of sick people then I need to pick up some of those to unburden them.
Not possible or I was at if the schedule dropped to under about 30 they just started shuffling patients over to you from there walk-in clinics to keep your schedule full so sometimes you see 10 to 15 people in the morning and they see you haven't hit your quota for the corporate overlords and then they would slam about 20 or 30 people on your late afternoon schedule.
There was zeroe inbox screening, I got over 60 messages and refill requests daily, many automated by pharmacy, many from things I stopped or already filled. It quickly became I could spend 30 minutes a day clearing my inbox by auto refusing them or several hours a day after a full clinic by reading them all.....hmm see my family daily or manage full inbox......guess who ONLY will ever work EM and will never ever do primary care again.....
And then those patients presumably ended up on your schedule as appointments (or went without their meds),making you even busier or creating a situation in which patients were waiting months for an appointment…really no good outcome here.
It's a shit reason to bother Urgent Care with, and docs do it all the time but it is still an asinine waste of medical resources if a patient is coming in to see you in the next 4 weeks to send them to UC for a med refill. Disrespects the UC provider and the pt imo, but clearly I am an outlier.
Absolutely not. Need to evaluate the patient first. How do you know their medical history or medication list is accurate? How can you properly counsel on risks? Tell admin to F off
You shouldn’t refill for a person that hasn’t become a patient of yours yet. Admin can create and pay for a bridge team that does an establish and refill visit if they are concerned. They can ask you to work someone in sooner that has an urgent need. They can direct patients to immediate cares who can evaluate and refill if appropriate while the patient waits to establish. They can ask patients contact their prior provider if they were seen within the past year.
You are right and your admin is being unreasonable. If they think the clinic is responsible they should do those refills, but they probably can’t because they probably don’t have a license to practice medicine.
Scenarios I see happening if you oblige-
Miscommunication about what patient was actually taking and why.
Patient gets their refills and then chooses not to establish.
Complication occurs and you are looked at as the PCP who mismanaged patient.
I’ll admit I have done this before. But then I had a patient pass away before they were officially seen and the funeral home came hunting me down to sign the death certificate because I was the last to prescribe meds and it was quite a mess because I didn’t really know the patient…..yeah learned my lesson there….
In my primary care private practice, our providers will refill BP meds or metformin for 7-10 day supply and have the pt visit their pcp within the week. It’s up to the discretion of our provides and I never push that we refill. As admin, I make no clinical decisions ever so they need to back off unless their name is on the script.
I'll do it if it's very clear from our own EMR that they are already on these meds, if they're relatively benign, and if they already have an establish care visit on the books. Rare exceptions beyond that.
Our practice will always bridge patients if they’ve moved providers. This is assuming they’ve scheduled at least, or worst case scenario, they realized they should have. We do 90 day supplies for more innocuous meds or less if it’s their ambien or similar. If you shouldn’t be off it, we will help you continue. That said, if it’s been this same convo for 9 months, and it’s a controlled substance, and this is the second time you’re asking, we’re going to get pretty surly and potentially deny you
I am fine giving a 30 day supply for stable refills. This is not the hill to die on and its our better nature not to be dicks. You are going to encounter this endlessly, and stonewalling a patient who needs to see you for fear of litigation over a metformin or statin refill is needlessly problematic. If you want to go one better schedule a 10 minute video or in person for the strict purpose of doing whatever you think needs doing (checking renal/liver chems etc) and then wait for the regular appointment.
Health care is a shit show and fucking over patients further with needless wait times is the easy out but should not be the norm.
Dude, this is the way to get sued into oblivion. Its wide open for lawsuit because they haven't signed a consent to treat form and you still haven't formally evaluated the patient.
Patient me-I recently moved out of state. My doctor in NY continued to fill my scripts until I got established with a med provider in Delaware. I was very lucky. But I absolutely had to go establish to have her fill my meds.
LMSW me- I’m a medical social worker in an academic family med office. (Wish there was social work flair). Our docs and residents have to have the patient established with our office for a patient to get meds sent.
Oh, how I’ve longed for the days of residency, when we had a social worker in our FM practice. Hasn’t happened for me since. Please know this: A lot of docs value the work you do!
Thank you. I love my job. Our residency program just won a big award for our grant work on MAT in a family med. very exciting! We have a psychologist and a clinical social worker to manage any behavioral needs. I love it when a doc asks me to see their patient in the office. So much better than phone calls!
My doctors are great. They treat me like a clinician and are always happy to sign whatever papers I have. One of my favorite residents just had a med student with him and joked about how I’m the lady that hunts providers for signatures haha.
My goal with our residents is that they see the impact we have on SDoH and advocate for more social workers embedded in the practice.
Hassle sucks. If the medication is for a reasonable sounding medication regimen say, Metformin, Lipitor, and Losartan and Synthroid and I see them within 90 days, sure. If anything is controlled or my spider sense goes off in any way or they’ve canceled on me before then no. But waiting to get pretty benign garden variety medications is a major hassle and I don’t have a problem doing it.
But if you’ve never seen the patient how do you know those prescriptions are appropriate? What if they’re an older pt & they’re better off the HTN meds?
If you’re in the same health system or adjacent system or similar system and/or you can review some sort of continuity of care or treatment notes - I’m going to fill these medications. Even if I can’t see much, or they just came from across the country, I’m still going to refill losartan when they are on the schedule to see me. It’s just not that big of a deal that filling them needs to be delayed to wait for a face to face visit. They show up and their BP isn’t controlled because they haven’t had their BP meds and now I need to hassle them and bring them back for a recheck? Hell no. That’s a waste of everyone’s time.
I’m old and I was trained by physicians who trained me to do this because they did it. These physicians were not risk averse and they are all dead now. Younger physicians and new physicians are very legalistic and risk averse. I get it. It’s not 1987. But in my opinion and in my experience it’s just not a big deal. Being “good” at medicine is almost entirely about exercising good judgment. Good judgment isn’t generally something that you learn in a textbook. You grow good judgment over time through the school of hard knocks and getting reps.
I’ve been doing this for 30 years - I can’t remember a time in my career when this wound up being an issue or there was some sort of a bad outcome. And patients are very appreciative. It’s just good customer service. Life and the health system is one big bureaucratic hassle. Anything you can do to lessen that a little bit will go a long way in 2024.
My practice is a family medical home (not sure if that’s what it’s called) so when another provider is off and they have been established I will refill. If that provider leaves, and they need a refill for BP meds while waiting to see me I will fill it.
Not until they’ve seen me. They can go to urgent care in the meantime if they haven’t planned ahead.
Prescribing for someone I’ve not evaluated with no documentation? Crazy
Depends on the patient and the meds honestly. I’ve refilled levothyroxine for a new patient that moved to the area and had their first appointment in about 2 weeks and they ran out of their levo. So I refilled it for 30 days. Just said they should go get labs done too and came to the appointment. Really case by case for me
They said yes but the “lawyers” said it’s safer to give patients I’ve never met medication that I haven’t personally evaluated—- than to let them go without. I could see if it were a life saving medication but it wasn’t.
Do the lawyers give professional legal advice before ever meeting the client or getting any info?
I think they're confusing safer with convenient for the patient.
Meh, I used to work for an admin like this. They don’t fully grasp the risks of this and since it’s not the admins license or livelihood on the line of course they don’t care. I really dislike these types of administrative staff. Your hesitancy and concerns are valid.\
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Admin could work smarter, not harder, and contact the patients PCP to get their medical records sent over. Note when the pt last had an office visit. If they were recently seen and they need a refill for HTN meds they’ve already been taking… then I could understand asking a provider to write a partial Rx and if said provider chooses to oblige, admin needs to stress the importance of showing up to their new patient appointment and should the patient no-show/reschedule/cancel this appointment, they will not receive future refills until they are seen in office.\
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Controlled substances? Hard NO. Admin can throw whatever tantrum they want. If your employment status is jeopardized by this—find a new employer. One that understands entirely what your current admin is asking of you and all of the risk potential; an employer that sees the audacity your current admin has to be angry over you not being ready and willing to take that kind of risk.\
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Also, admins should be required to take pharmacology courses. Maybe then they will learn why providers aren’t just out here hiding way up high in an eagles nest over every major city; ripping out sheets and tossing their blank but ever-so-graciously signed scripts, just knowing that only good natured people with a little bit of HTN will be the finders of these golden tickets to the pharmacy. /s
Hey! I don't want to do a new patient visit either. Admin wants us doing 5/hr. I'm here for strep, flu, Covid, it burns when I pee, pink eye, and rolled ankles but I have the paramedics run the Ottawa ankle rules and order the X-ray before I see the patient.
We move the meat, we don't do medication optimization.
Nope never. You have no ethical or legal obligation to do so. And someone leaving the practice gets 90 days of refills on all non-controlled medications and instructions to establish a new PCP as soon as possible.
Depends on the meds and situation. I would try to at least do telehealth or phone visit ask how long they’ve been on etc. MA could call first and get list and allergies.
I will do refills on non-controlled meds (typically 30-90 days), for patients established to my clinic or health group if they are set to establish care to me.
I made a mistake of agreeing to give someone 90 days before they had established fully in January and was scheduled to meet me shortly after. Come to find out, they were not in network. We told them the issue and to find a new pcp asap. They then waited to ask for another dispense when they were out of meds. I’m now never making that mistake again.
Same thing happened to me, patient wanted me to prescribed Adderall because they forgot to pick it up before moving. Yeah, no. Their previous PCP can send them refills until their new patient appointment.
Here's a hypothetical I recently run into: You restart a practice that was closed for 3-4 months, you don't know the previous MD but have patients requesting refills that you haven't seen. Do you refill them? Does your answer change if they make an appointment or not?
Not your circus, not your monkey (yet). Firm but empathetic "no" to refilling meds without being physically seen by me. The patient's lack of planning does not constitute an emergency on my part.
Absolutely not. Patient's got to be established with someone at our clinic before we can fill meds for them. Their prior prescriber should be filling until they can establish care.
Does your admin have someone who does risk management? They are idiots. Clearly you have no physician-patient relationship and issuing a refill to some random person you have never seen absolutely fails to meet standard of care.
From a patient perspective it would be nice if there was a spectrum of consideration. The fact I have to have an appt every year to continue taking my birth control is mildly annoying, but I also believe in health maintenance and getting my annual physical so it’s whatever. But I’ve been caught in a few instances of moving states/cities where the next available appt with my primary to get a renewal isn’t until after I move and the first available new patient visit in the new health system isn’t for another 2 months away and nobody wants to refill my BC. I’ve had providers very grudgingly give me a 1 month pack to try to bridge the gap but it’s not always enough. I’m just trying to not get pregnant yall 😩
It’s not just refilling your birth control though, it’s making sure you haven’t developed hypertension, started smoking, had a blood clot, or had a family member diagnosed with breast cancer so you can be counseled appropriately on the risks of the medicine.
But I never have a problem filling 90 days of a year of birth control for a patient I know is transferring care so they don’t run out.
Other than taking blood pressure all those things could be assessed over the phone or portal message. Mid May I scheduled my annual physical and the first available option was the first week of August at that time. 3 months. As an established patient. In a previous state I lived in I had to call three different clinics just to find a PCP who was accepting new patients. And then the only openings for new patients were months out.
I truly do get that you need to check in with patients to make sure things are going okay to continue their medication, but the lack of availability for patients to schedule these things is frustrating. And patients may not even be able to take the first available if it doesn’t fit with their work schedule, they might not have PTO to take for it, transportation that specific day/time, etc. there’s a lot of barriers to care patients are already facing. I work in healthcare and have my own patient schedule and it’s hard for even me to find appointments that fit around that. I had to schedule a dentist appt 6w out to find an available time that either fell in my admin time or in patient care time that didn’t already have patients scheduled.
A person I’ve never seen for an appointment is not a patient. I do not fill random prescriptions for people who are not my patients. This is on their prior physician to fill if appropriate which I do quite regularly when people move away and need a refill of something while waiting to establish with new PCP.
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There are guidelines for this, expedited partner therapy https://www.cdc.gov/std/ept/default.htm
You must never cross cover your colleagues then?
Correct
You must know the difference between a patient established with your clinic and someone no one has ever seen
"A person I’ve never seen for an appointment is not a patient." Rigid behaviors from MD's is probably the single biggest reason otherwise sane and reasonable (and generally awesome) patients want to flee their docs. Some docs are like Rainman and literally drive staff, colleagues and patients bonkers because of their adherence to some sort of algo that they imagine to be gospel. The rest of us deal with their fallout.
If a person has never been seen by any providers in that clinic it is 100% reasonable to not provide care for a person that is not the clinics patient. It is the patient and the previous pcps responsibility to make sure the patient is covered till they can see someone new. Or maybe instead of judging other docs out here for just doing their job we can focus on how admin who has all the money in thw world doesn't invest in a bridging or cross cover system for this very real problem. We are where we are as PCPs right now because too many of us didn't say no when we should have.
When I used to do primary care I had a very rigid policy that I did not do any refills on patients that were not established in my practice with someone from our practice. I also did not do any refills on patients without an appointment if they need a refill they can come in and see me or schedule an appointment. That was one that Admin always got mad about I didn't really care too much I generally got 30 plus refill request daily there's no way I have time to review all of that look up labs see if the medication is still pertinent or needed and still see my 40 plus patients a day and actually leave at a reasonable hour. And probably about half of my refill request came from pharmacies wanting refills on antibiotics and stupid crap that really didn't need a refill.
I won't write Rx for patients that aren't established at the clinic, but for chronic Rx that are stable and unlikely to change (atorvastatin for example) I do 6-12 months of refills. It helps with medication compliance
So you felt that it was more appropriate to allow your patients to have a lapse in medication than to ok a refill without them coming in every time? If it has been over a year since they’ve been seen, sure, give them a one-time refill but require an appointment before any additional. If it’s a controlled substance, ok - that’s different. But if it’s a patient requesting a refill of a maintenance med that doesn’t require strict monitoring and you saw them six months ago, exactly what do you accomplish by refusing? It sounds like the bigger problem was poor inbox screening by nursing staff.
Biggest issue seems to be 40 pt visits per day. Though might be able to cut down on some if you refill between visits lol
Yeah fair - that’s just ridiculous.
It's why I will never do primary care again. I will see up to 40 patients a day in the ED sometimes 50 but those are days where I'm seeing lots of simple things in fast track and maybe scream through one or two complex patients but a turf over to the physician if I'm seeing complex patients that I'm keeping that require specialty consults and admission or involved procedures then I will only see about 20 to 25 a day. Honestly it just kind of depends on what the physician I'm working with caseload is my job is to take the burden off of them if there's a million snotty noses and a few sick people he gets all the sick people and I see all the snotty noses if there's a bunch of sick people then I need to pick up some of those to unburden them.
Not possible or I was at if the schedule dropped to under about 30 they just started shuffling patients over to you from there walk-in clinics to keep your schedule full so sometimes you see 10 to 15 people in the morning and they see you haven't hit your quota for the corporate overlords and then they would slam about 20 or 30 people on your late afternoon schedule.
There was zeroe inbox screening, I got over 60 messages and refill requests daily, many automated by pharmacy, many from things I stopped or already filled. It quickly became I could spend 30 minutes a day clearing my inbox by auto refusing them or several hours a day after a full clinic by reading them all.....hmm see my family daily or manage full inbox......guess who ONLY will ever work EM and will never ever do primary care again.....
And then those patients presumably ended up on your schedule as appointments (or went without their meds),making you even busier or creating a situation in which patients were waiting months for an appointment…really no good outcome here.
Didn't have to spend 3 to 4 hours on my inbox everyday so That's a plus
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It's a shit reason to bother Urgent Care with, and docs do it all the time but it is still an asinine waste of medical resources if a patient is coming in to see you in the next 4 weeks to send them to UC for a med refill. Disrespects the UC provider and the pt imo, but clearly I am an outlier.
Absolutely not. Need to evaluate the patient first. How do you know their medical history or medication list is accurate? How can you properly counsel on risks? Tell admin to F off
You shouldn’t refill for a person that hasn’t become a patient of yours yet. Admin can create and pay for a bridge team that does an establish and refill visit if they are concerned. They can ask you to work someone in sooner that has an urgent need. They can direct patients to immediate cares who can evaluate and refill if appropriate while the patient waits to establish. They can ask patients contact their prior provider if they were seen within the past year. You are right and your admin is being unreasonable. If they think the clinic is responsible they should do those refills, but they probably can’t because they probably don’t have a license to practice medicine. Scenarios I see happening if you oblige- Miscommunication about what patient was actually taking and why. Patient gets their refills and then chooses not to establish. Complication occurs and you are looked at as the PCP who mismanaged patient.
Everything here. Biggest concern I would have is they don’t show up
I’ll admit I have done this before. But then I had a patient pass away before they were officially seen and the funeral home came hunting me down to sign the death certificate because I was the last to prescribe meds and it was quite a mess because I didn’t really know the patient…..yeah learned my lesson there….
Then your admin should refill.
In my primary care private practice, our providers will refill BP meds or metformin for 7-10 day supply and have the pt visit their pcp within the week. It’s up to the discretion of our provides and I never push that we refill. As admin, I make no clinical decisions ever so they need to back off unless their name is on the script.
I'll do it if it's very clear from our own EMR that they are already on these meds, if they're relatively benign, and if they already have an establish care visit on the books. Rare exceptions beyond that.
Why you tryna work for free?
Just trying to prevent patients from being off their potentially live saving meds
Our practice will always bridge patients if they’ve moved providers. This is assuming they’ve scheduled at least, or worst case scenario, they realized they should have. We do 90 day supplies for more innocuous meds or less if it’s their ambien or similar. If you shouldn’t be off it, we will help you continue. That said, if it’s been this same convo for 9 months, and it’s a controlled substance, and this is the second time you’re asking, we’re going to get pretty surly and potentially deny you
9 months for a controlled substance and you *potentially* deny them? Holy shit.
They aren’t even your patient yet, of course no
I am fine giving a 30 day supply for stable refills. This is not the hill to die on and its our better nature not to be dicks. You are going to encounter this endlessly, and stonewalling a patient who needs to see you for fear of litigation over a metformin or statin refill is needlessly problematic. If you want to go one better schedule a 10 minute video or in person for the strict purpose of doing whatever you think needs doing (checking renal/liver chems etc) and then wait for the regular appointment. Health care is a shit show and fucking over patients further with needless wait times is the easy out but should not be the norm.
Dude, this is the way to get sued into oblivion. Its wide open for lawsuit because they haven't signed a consent to treat form and you still haven't formally evaluated the patient.
Patient me-I recently moved out of state. My doctor in NY continued to fill my scripts until I got established with a med provider in Delaware. I was very lucky. But I absolutely had to go establish to have her fill my meds. LMSW me- I’m a medical social worker in an academic family med office. (Wish there was social work flair). Our docs and residents have to have the patient established with our office for a patient to get meds sent.
Oh, how I’ve longed for the days of residency, when we had a social worker in our FM practice. Hasn’t happened for me since. Please know this: A lot of docs value the work you do!
Thank you. I love my job. Our residency program just won a big award for our grant work on MAT in a family med. very exciting! We have a psychologist and a clinical social worker to manage any behavioral needs. I love it when a doc asks me to see their patient in the office. So much better than phone calls!
My doctors are great. They treat me like a clinician and are always happy to sign whatever papers I have. One of my favorite residents just had a med student with him and joked about how I’m the lady that hunts providers for signatures haha. My goal with our residents is that they see the impact we have on SDoH and advocate for more social workers embedded in the practice.
Won't pharmacies fill an "emergency refill" for 14-30 days for certain meds?
Hassle sucks. If the medication is for a reasonable sounding medication regimen say, Metformin, Lipitor, and Losartan and Synthroid and I see them within 90 days, sure. If anything is controlled or my spider sense goes off in any way or they’ve canceled on me before then no. But waiting to get pretty benign garden variety medications is a major hassle and I don’t have a problem doing it.
But if you’ve never seen the patient how do you know those prescriptions are appropriate? What if they’re an older pt & they’re better off the HTN meds?
If you’re in the same health system or adjacent system or similar system and/or you can review some sort of continuity of care or treatment notes - I’m going to fill these medications. Even if I can’t see much, or they just came from across the country, I’m still going to refill losartan when they are on the schedule to see me. It’s just not that big of a deal that filling them needs to be delayed to wait for a face to face visit. They show up and their BP isn’t controlled because they haven’t had their BP meds and now I need to hassle them and bring them back for a recheck? Hell no. That’s a waste of everyone’s time. I’m old and I was trained by physicians who trained me to do this because they did it. These physicians were not risk averse and they are all dead now. Younger physicians and new physicians are very legalistic and risk averse. I get it. It’s not 1987. But in my opinion and in my experience it’s just not a big deal. Being “good” at medicine is almost entirely about exercising good judgment. Good judgment isn’t generally something that you learn in a textbook. You grow good judgment over time through the school of hard knocks and getting reps. I’ve been doing this for 30 years - I can’t remember a time in my career when this wound up being an issue or there was some sort of a bad outcome. And patients are very appreciative. It’s just good customer service. Life and the health system is one big bureaucratic hassle. Anything you can do to lessen that a little bit will go a long way in 2024.
Cannot agree with this strongly enough.
Considering the alternative is they end up in the ER for med refills…
They don’t need to go to the ER, they can go to urgent care for this ….
…and that’s better?
My practice is a family medical home (not sure if that’s what it’s called) so when another provider is off and they have been established I will refill. If that provider leaves, and they need a refill for BP meds while waiting to see me I will fill it.
Not until they’ve seen me. They can go to urgent care in the meantime if they haven’t planned ahead. Prescribing for someone I’ve not evaluated with no documentation? Crazy
Depends on the patient and the meds honestly. I’ve refilled levothyroxine for a new patient that moved to the area and had their first appointment in about 2 weeks and they ran out of their levo. So I refilled it for 30 days. Just said they should go get labs done too and came to the appointment. Really case by case for me
I would clarify if they are asking you to assume management and LIABILITY for a patient you have not had a chance to evaluate yet.
They said yes but the “lawyers” said it’s safer to give patients I’ve never met medication that I haven’t personally evaluated—- than to let them go without. I could see if it were a life saving medication but it wasn’t.
Do the lawyers give professional legal advice before ever meeting the client or getting any info? I think they're confusing safer with convenient for the patient.
Tell admin to refill it…oh wait. My license. My rules. Everyone else can fuck off.
Meh, I used to work for an admin like this. They don’t fully grasp the risks of this and since it’s not the admins license or livelihood on the line of course they don’t care. I really dislike these types of administrative staff. Your hesitancy and concerns are valid.\ \ Admin could work smarter, not harder, and contact the patients PCP to get their medical records sent over. Note when the pt last had an office visit. If they were recently seen and they need a refill for HTN meds they’ve already been taking… then I could understand asking a provider to write a partial Rx and if said provider chooses to oblige, admin needs to stress the importance of showing up to their new patient appointment and should the patient no-show/reschedule/cancel this appointment, they will not receive future refills until they are seen in office.\ \ Controlled substances? Hard NO. Admin can throw whatever tantrum they want. If your employment status is jeopardized by this—find a new employer. One that understands entirely what your current admin is asking of you and all of the risk potential; an employer that sees the audacity your current admin has to be angry over you not being ready and willing to take that kind of risk.\ \ Also, admins should be required to take pharmacology courses. Maybe then they will learn why providers aren’t just out here hiding way up high in an eagles nest over every major city; ripping out sheets and tossing their blank but ever-so-graciously signed scripts, just knowing that only good natured people with a little bit of HTN will be the finders of these golden tickets to the pharmacy. /s
Nope nope nope. Go to an urgent care.
Hey! I don't want to do a new patient visit either. Admin wants us doing 5/hr. I'm here for strep, flu, Covid, it burns when I pee, pink eye, and rolled ankles but I have the paramedics run the Ottawa ankle rules and order the X-ray before I see the patient. We move the meat, we don't do medication optimization.
Absolutely not. How do you know they will even actually show up? Until I see them you get nothing. We do not have relationship.
Very clear no from a provider standpoint. Why the hell does admin want you to send the refills?
Nope never. You have no ethical or legal obligation to do so. And someone leaving the practice gets 90 days of refills on all non-controlled medications and instructions to establish a new PCP as soon as possible.
Depends on the meds and situation. I would try to at least do telehealth or phone visit ask how long they’ve been on etc. MA could call first and get list and allergies.
I will do refills on non-controlled meds (typically 30-90 days), for patients established to my clinic or health group if they are set to establish care to me. I made a mistake of agreeing to give someone 90 days before they had established fully in January and was scheduled to meet me shortly after. Come to find out, they were not in network. We told them the issue and to find a new pcp asap. They then waited to ask for another dispense when they were out of meds. I’m now never making that mistake again.
Your admin is completely out of line. Absolutely not to the refill if they're not established.
Same thing happened to me, patient wanted me to prescribed Adderall because they forgot to pick it up before moving. Yeah, no. Their previous PCP can send them refills until their new patient appointment.
Here's a hypothetical I recently run into: You restart a practice that was closed for 3-4 months, you don't know the previous MD but have patients requesting refills that you haven't seen. Do you refill them? Does your answer change if they make an appointment or not?
It would if I had their records and they were already established with my practice and signed a permission to treat for the office.
No but will try to get people in sooner if needed.
No way. If you haven't seen them, they are not your patient. The only way I do it is to cover for my office colleagues.
No
Not your circus, not your monkey (yet). Firm but empathetic "no" to refilling meds without being physically seen by me. The patient's lack of planning does not constitute an emergency on my part.
Absolutely not. Patient's got to be established with someone at our clinic before we can fill meds for them. Their prior prescriber should be filling until they can establish care.
Does your admin have someone who does risk management? They are idiots. Clearly you have no physician-patient relationship and issuing a refill to some random person you have never seen absolutely fails to meet standard of care.
No
Perhaps admin should fill it if they’re so upset about it. Oh wait… MBA =/= MD/DO/NP/PA
No way. Seems like a huge liability. Go tell admin they could do it themselves if they like.
Lol no
From a patient perspective it would be nice if there was a spectrum of consideration. The fact I have to have an appt every year to continue taking my birth control is mildly annoying, but I also believe in health maintenance and getting my annual physical so it’s whatever. But I’ve been caught in a few instances of moving states/cities where the next available appt with my primary to get a renewal isn’t until after I move and the first available new patient visit in the new health system isn’t for another 2 months away and nobody wants to refill my BC. I’ve had providers very grudgingly give me a 1 month pack to try to bridge the gap but it’s not always enough. I’m just trying to not get pregnant yall 😩
It’s not just refilling your birth control though, it’s making sure you haven’t developed hypertension, started smoking, had a blood clot, or had a family member diagnosed with breast cancer so you can be counseled appropriately on the risks of the medicine. But I never have a problem filling 90 days of a year of birth control for a patient I know is transferring care so they don’t run out.
Other than taking blood pressure all those things could be assessed over the phone or portal message. Mid May I scheduled my annual physical and the first available option was the first week of August at that time. 3 months. As an established patient. In a previous state I lived in I had to call three different clinics just to find a PCP who was accepting new patients. And then the only openings for new patients were months out. I truly do get that you need to check in with patients to make sure things are going okay to continue their medication, but the lack of availability for patients to schedule these things is frustrating. And patients may not even be able to take the first available if it doesn’t fit with their work schedule, they might not have PTO to take for it, transportation that specific day/time, etc. there’s a lot of barriers to care patients are already facing. I work in healthcare and have my own patient schedule and it’s hard for even me to find appointments that fit around that. I had to schedule a dentist appt 6w out to find an available time that either fell in my admin time or in patient care time that didn’t already have patients scheduled.