"Out of sinemet" is an anagram for "Omit use often" which might be pertinent given the second phrase in the fax. We can only hope the patient subsequently inspired.
We did a three month study in our office on pharmacy faxes.
88% were for patients who: were no longer on that med; had died; had moved away; had filled their script at another pharmacy; had a hard copy script that they would use when needed; were seeing another doc; etc. etc.
Anonymous @ 8:50: Faxing a physician's office for patient refills is not our idea of fun either. Many patients DEMAND that we fax for a med that they have never taken or haven't taken for years. As far as the patient having a hard copy of an rx, unless they give it to us to put on hold, we have no way of knowing it exists. Same with them going to a new doctor. We are not mind readers. This entire problem could easily be solved if the we all followed one simple rule. The physician prescribes, the pharmacy dispenses. This BS of "hang up and have your pharmacy contact us" is a total load of crap and is an easy way of doctor's offices to get out of doing their jobs.
Says Geoff Brown moments before he faxes a 40 page , brief, home inspection report, contract, lease or the like to a colleague at the Bar. I love the anal approach of many lawyers, they fax and then they mail the original "Hard Copy". You know there is trouble brewing when you tell them to scan and E Mail and they say do what ?
Oh, crap the toner cartridge has expired, please authrize more refills.
On the subject of authorizing refills. I have been going to the same Dr. and using the same Pharmacy for 6 years. During that time I have been on the same daily hypertension drug continuously. I just had my annual physical and still my prescription says "no refills" necessitating that the pharmacy call the Drs office monthly. I suppose there is a reason for this but it escapes me.
RichG, in the primary care world this can be used to catch quality measures that insurance companies and NCQA require (in your care of HTN that would be the controlling high blood pressure measure and probably a BMP or CMP if you're on an ACE/ARB or diuretic). However, all those refill phone calls and faxes are a big expense to both the pharmacy and the physician office.
"no longer on that medication" -usually the pharmacy IS NOT NOTIFIED, so we keep filling the prescripion when asked by the patient since it is still a valid script -"had died" that has happened to us, since we refax every 3 days and if it is 3 weeks later and you STILL haven't responded, yes the patient had died -"had filled the script at another pharmacy" perhaps. But the patient called ME to refill the medication and did not let me know it is elsewhere (or know they don't have refills there/want it early here) -"were seeing another doctor" I will fax it to the last doctor who wrote it. The patient's aren't very good about letting me know about a doctor change (they expect me to mind read) -"had a hard copy that they will use when needed" REALLY??? Do you really think the patient still has that? NO!!!! And if they do, they didn't exactly give it to us now, did they?
You must be that office I keep faxing and faxing and faxing too. I know you get annoyed when I make the patient call you, but maybe you should just get back to be with the medication YOU prescribed for YOUR patient.
Yes, let's not get started on the auto-fax, auto-fill, and the auto-script... . E-prescribing is not the most pleasant paper-chase encounter in the world with the 1.6572 mLs of medication per dose, unexpected dosage forms ordered, and deciphering of intent...yes, it is quite legible, now that the standard font is used, but it's still as slog sometimes with lack of standardization across the board. On the other hand, our western fear of monopolies and the fact that the megalomanics at Surescripts sells services at cost of every single fax to pharmacies, not the prescribers, ... and every aspect of the pharmacist work-life from raw drug supplier to proprietary & generic drug manufacturers and drug companies, to drug wholesalers, delivery truck drivers, to PBMs, the $4.00/Rx shops and other big retail chains, etc. (even patients) like to tell pharmacist how to do their job.
It's the pharmacies (not the physician) that is charged for every fax from the doctors' offices, and thus is met with some resistance understandably from the pharmacist viewpoint.
Sometimes it's a wonder we aren't all zombies on auto-pilot navigating through our lives.
Not bitter.
Sometimes the bugs need to be led out of the system with honey rather than stomping.
@ Packer -- can't remember the last time I faxed anything, actually, and I get annoyed when someone insists on faxing or mailing me stuff instead of emailing it. But even the old guard is coming around on that. It seems like it's mostly the solos who insist on faxing everything because they only just now figured out how to do THAT, or something.
Anonymous @ 8:50, I'm starting to wonder whether you work at my primary care physician's office.
Awhile back they switched to e-prescribing. And I don't know what happened next, but I do know that it now takes them a ridiculously long time to authorize a refill.
I'm not talking about situations in which the doctor says, "The patient has to come see me before I will authorize any more refills." I get that, even if I don't like it. And I'm not talking about times when I mess up and only let the pharmacy know I want a refill on Friday afternoon and the pharmacy doesn't get a response from the doctor until the following Monday, either.
I'm talking about situations in which the doctor wants me to continue to take the same dose of the same med at the same time of day as in the past (and in some cases he will yell at me because I stopped taking the med once I ran out and could not get more), but after I contact the pharmacy, it can take a couple of weeks before the office will respond. One time, it took 4 months of both me and the pharmacy calling several times a week. I had an appointment about 4 days after they finally did send the new authorization that time, and when I told my doctor about it he assured me that it must have been the pharmacist's fault. Well, I see 2 specialists in addition to my primary care doctor, and I've never had this problem with anything either of them prescribes me, but for the first 8 months that they had the new "upgraded" computer system that included e-prescriptions, it happened with every single medication from my PCP's office that needed a reauthorization.
Just as I was getting ready to tell my doctor, "I think you're a great doctor and I have been lucky to be your patient, but I'm going to need to find a different PCP because it's not good for me to keep going on and off some of these meds that enable me to function," they started getting it right. And for a couple of years, everything went smoothly.
Then suddenly, it took 3 weeks to get a refill of my acid reflux med, and the pharmacy is saying, "They won't respond to anything we send them." That's not a good thing to come off cold turkey -- all of a sudden, repeatedly, in the middle of sleeping or working or whatever, my mouth was full of really nasty stuff. I'm really hoping that this is a one-time issue, because other than this the guy really is the best PCP I've ever had.
If I found out that my doctor's office was just throwing out the pharmacy's attempts to get them to reauthorize medication that I take every day, that the doctor wants me to continue to take every day, that has a significant effect on my quality of life, and that the doctor is not withholding to force me to come into the office and see him, I would be leaving the practice ASAP.
The more I read on this blog, the more I appreciate Kaiser as my HMO. They have a computer system for records and for scripts, and it flows well. I have few problems with any of those things, and all my doctors and the ER can see all my files. In addition, they never give trouble authorizing MRIs or other tests, even just a few months after a previous clean MRI if my doctor thinks it's necessary.
"Out of sinemet" is an anagram for "Omit use often" which might be pertinent given the second phrase in the fax. We can only hope the patient subsequently inspired.
ReplyDeleteWe did a three month study in our office on pharmacy faxes.
ReplyDelete88% were for patients who: were no longer on that med; had died; had moved away; had filled their script at another pharmacy; had a hard copy script that they would use when needed; were seeing another doc; etc. etc.
We just shred them all now.
Maybe s/he was a pharaoh and needed it for the after life, Or a cat with 9 lives.
ReplyDeleteAnonymous @ 8:50: Faxing a physician's office for patient refills is not our idea of fun either. Many patients DEMAND that we fax for a med that they have never taken or haven't taken for years. As far as the patient having a hard copy of an rx, unless they give it to us to put on hold, we have no way of knowing it exists. Same with them going to a new doctor. We are not mind readers.
ReplyDeleteThis entire problem could easily be solved if the we all followed one simple rule. The physician prescribes, the pharmacy dispenses.
This BS of "hang up and have your pharmacy contact us" is a total load of crap and is an easy way of doctor's offices to get out of doing their jobs.
And I thought the legal profession was the last bastion of the fax machine. And even we're phasing them out.
ReplyDeleteSays Geoff Brown moments before he faxes a 40 page , brief, home inspection report, contract, lease or the like to a colleague at the Bar. I love the anal approach of many lawyers, they fax and then they mail the original "Hard Copy".
ReplyDeleteYou know there is trouble brewing when you tell them to scan and E Mail and they say do what ?
Oh, crap the toner cartridge has expired, please authrize more refills.
"And be quick about it. We need to move as much product as possible before his insurance company figures it out."
ReplyDeleteOn the subject of authorizing refills. I have been going to the same Dr. and using the same Pharmacy for 6 years. During that time I have been on the same daily hypertension drug continuously. I just had my annual physical and still my prescription says "no refills" necessitating that the pharmacy call the Drs office monthly. I suppose there is a reason for this but it escapes me.
ReplyDeleteRichG, in the primary care world this can be used to catch quality measures that insurance companies and NCQA require (in your care of HTN that would be the controlling high blood pressure measure and probably a BMP or CMP if you're on an ACE/ARB or diuretic). However, all those refill phone calls and faxes are a big expense to both the pharmacy and the physician office.
ReplyDeleteHow does one refill a patient?
ReplyDelete@ anony 8:50
ReplyDelete"no longer on that medication" -usually the pharmacy IS NOT NOTIFIED, so we keep filling the prescripion when asked by the patient since it is still a valid script
-"had died" that has happened to us, since we refax every 3 days and if it is 3 weeks later and you STILL haven't responded, yes the patient had died
-"had filled the script at another pharmacy" perhaps. But the patient called ME to refill the medication and did not let me know it is elsewhere (or know they don't have refills there/want it early here)
-"were seeing another doctor" I will fax it to the last doctor who wrote it. The patient's aren't very good about letting me know about a doctor change (they expect me to mind read)
-"had a hard copy that they will use when needed" REALLY??? Do you really think the patient still has that? NO!!!! And if they do, they didn't exactly give it to us now, did they?
You must be that office I keep faxing and faxing and faxing too. I know you get annoyed when I make the patient call you, but maybe you should just get back to be with the medication YOU prescribed for YOUR patient.
Yes, let's not get started on the auto-fax, auto-fill, and the auto-script... . E-prescribing is not the most pleasant paper-chase encounter in the world with the 1.6572 mLs of medication per dose, unexpected dosage forms ordered, and deciphering of intent...yes, it is quite legible, now that the standard font is used, but it's still as slog sometimes with lack of standardization across the board. On the other hand, our western fear of monopolies and the fact that the megalomanics at Surescripts sells services at cost of every single fax to pharmacies, not the prescribers, ... and every aspect of the pharmacist work-life from raw drug supplier to proprietary & generic drug manufacturers and drug companies, to drug wholesalers, delivery truck drivers, to PBMs, the $4.00/Rx shops and other big retail chains, etc. (even patients) like to tell pharmacist how to do their job.
ReplyDeleteIt's the pharmacies (not the physician) that is charged for every fax from the doctors' offices, and thus is met with some resistance understandably from the pharmacist viewpoint.
Sometimes it's a wonder we aren't all zombies on auto-pilot navigating through our lives.
Not bitter.
Sometimes the bugs need to be led out of the system with honey rather than stomping.
Packer: your comments make no sense.
ReplyDelete@ Packer -- can't remember the last time I faxed anything, actually, and I get annoyed when someone insists on faxing or mailing me stuff instead of emailing it. But even the old guard is coming around on that. It seems like it's mostly the solos who insist on faxing everything because they only just now figured out how to do THAT, or something.
ReplyDeleteAnonymous @ 8:50, I'm starting to wonder whether you work at my primary care physician's office.
ReplyDeleteAwhile back they switched to e-prescribing. And I don't know what happened next, but I do know that it now takes them a ridiculously long time to authorize a refill.
I'm not talking about situations in which the doctor says, "The patient has to come see me before I will authorize any more refills." I get that, even if I don't like it. And I'm not talking about times when I mess up and only let the pharmacy know I want a refill on Friday afternoon and the pharmacy doesn't get a response from the doctor until the following Monday, either.
I'm talking about situations in which the doctor wants me to continue to take the same dose of the same med at the same time of day as in the past (and in some cases he will yell at me because I stopped taking the med once I ran out and could not get more), but after I contact the pharmacy, it can take a couple of weeks before the office will respond. One time, it took 4 months of both me and the pharmacy calling several times a week. I had an appointment about 4 days after they finally did send the new authorization that time, and when I told my doctor about it he assured me that it must have been the pharmacist's fault. Well, I see 2 specialists in addition to my primary care doctor, and I've never had this problem with anything either of them prescribes me, but for the first 8 months that they had the new "upgraded" computer system that included e-prescriptions, it happened with every single medication from my PCP's office that needed a reauthorization.
Just as I was getting ready to tell my doctor, "I think you're a great doctor and I have been lucky to be your patient, but I'm going to need to find a different PCP because it's not good for me to keep going on and off some of these meds that enable me to function," they started getting it right. And for a couple of years, everything went smoothly.
Then suddenly, it took 3 weeks to get a refill of my acid reflux med, and the pharmacy is saying, "They won't respond to anything we send them." That's not a good thing to come off cold turkey -- all of a sudden, repeatedly, in the middle of sleeping or working or whatever, my mouth was full of really nasty stuff. I'm really hoping that this is a one-time issue, because other than this the guy really is the best PCP I've ever had.
If I found out that my doctor's office was just throwing out the pharmacy's attempts to get them to reauthorize medication that I take every day, that the doctor wants me to continue to take every day, that has a significant effect on my quality of life, and that the doctor is not withholding to force me to come into the office and see him, I would be leaving the practice ASAP.
The more I read on this blog, the more I appreciate Kaiser as my HMO. They have a computer system for records and for scripts, and it flows well. I have few problems with any of those things, and all my doctors and the ER can see all my files. In addition, they never give trouble authorizing MRIs or other tests, even just a few months after a previous clean MRI if my doctor thinks it's necessary.
ReplyDelete