I may have to become sucky with my doctor's office (long)

[BeenThereDoneThat]

I've posted in a few other threads briefly about this situation. I had an appointment scheduled with my psychiatrist for this past Thursday morning. Thursday is normally my one weekday off, but then at the last minute I was scheduled for a cross-training class at work that was running from 9:30 AM - 5:30 PM. I couldn't miss it so I called the doctor's office a week early to explain.

Now, I realize it is not easy for doctors in the US to be able to make exceptions when prescribing certain medications due to FDA regulations. Usually they have to see you first and they can only prescribe a one-time amount for, say, a month's worth. No refills, you have to see them again first. In this case, though, I could not make another appointment (due to both holidays, my work schedule, his patient load and his upcoming vacation). I requested the office staff to talk to him and ask what could be done as I really would need my new prescriptions around the time my appointment was supposed to be. I believe the first time I called, I got voice mail, so I had to call back a couple of days later. This time I got someone on the phone but they said it would probably be 2-3 days for a callback. Christmas Eve, Christmas, and the day after Christmas (which we don't celebrate as Boxing Day in the US but nevertheless it was a federal holiday since Christmas Day was on a Sunday, so many places were closed Monday) passed by. I finally got a call on Wednesday, I think, and she had to leave voice mail for me because I was in class. She said she could call in my prescriptions but she needed my pharmacy phone #. Fine. I call back, get voice mail (of course) and leave all the info they need; requested a message back to let me know they'd gotten it. Heard nothing.

I called back Thursday at lunchtime and was put on hold for over 10 minutes, with nobody checking in to let me know how long it would be. Finally had to hang up, since my lunch is only 30 minutes. I called back at second break and got voice mail...AGAIN. Once again, I left my info and explained the urgency of the situation. Checked with my pharmacy later...nothing new.

Waited all day Friday for a callback or a message from the pharmacy about the scripts. Finally after class (and therefore after hours) I saw a message. I hoped it said my scripts had been called in. Nope. Just one of the front office staff saying she'd finally been able to call me back but she didn't know if the other person had filled my scripts or not. (Obviously not.) She was nice and she did all she could do; I was thankful at least that she called me.

So now it's a holiday weekend...again. I am completely out of my depression med. I can probably stretch the anxiety med to early next week but that's it, and that's the one that causes nasty side effects if you're off it too long. I am fed up. I will call again, either over the weekend or on Monday and will likely need to leave another message. I will ask for the office manager or whoever is doing her job that day to call me back so we can discuss this issue and I will tell her when is a good time to call me. Monday and Tuesday I'll still be in class; Wednesday I will be back on the floor and not until 11:30 AM so I can certainly "chat" with the OM then. I will start out being firm but civil, and see where it goes from there. I like my doctor, but I'm prepared to look for a new one with a much better office staff. Frankly, I think they are just too overwhelmed there...one or two psychiatrists and several other psychologists or social workers, with maybe 2-3 people behind the front desk at any given time (possibly one) and I don't know who all in the back office. I already know I don't like one of the higher ups that works there...I'm sure he's had to be firm because of some of the people he deals with, but he acts cold as well (IMO) and I have been a good patient for many years. Also, it's a bit far from home, so I could stand finding someone closer.

Thanks for reading my tirade.

[Sapphire Silk]

This is not an acceptable situation. Try to be polite but firm that this is not good patient care. Insist on speaking with a manager, and bring the situation up with your psychiatrist when you see him again.

Particularly since you are on medication that in general is not supposed to be stopped suddenly, this creates an unsafe situation for you.

If you are still out of your meds, and feeling badly, go to the emergency room and ask for a script to tide you over a few days until you get things straightened out with your regular doctor.

[BeenThereDoneThat]

Thanks Panacea. Just another thing to add to my list of changes to make in 2012, I guess...

[sms001]

Hafta concur w/ Panacea. Vital medication doesn't take a holiday. Not foreseeing such an eventuality is a pretty serious slip-up.

[Shalom]

One thing concerns me, though. If it's a medication that can't be prescribed with refills, then it's probably a Schedule II drug... and those can't be phoned in either, except under strictly circumscribed circumstances. (Doctor must declare that it is an emergency, can prescribe no more than a five day supply, and must provide a written script to cover the phone order within 72 hours. Moreover, that cover script only covers the phone order, and the doctor must utter a separate prescription if he wants to give a month's supply.)

From what you're saying here, I think it qualifies under the law as an emergency situation, but you're not likely to get a whole month on that phone order. Last I checked, Federal law still prohibits e-prescribing controls, and faxing them varies by state; I don't know Florida law so I can't comment on that.

I've had to refuse several times to accept telephoned prescriptions from one particular psychiatrist's office, who keeps trying to phone in a month's supply of Klonopin, which although it's only a C-IV, is treated by New York State the same as the C-IIs. I keep telling the office girl that I need a written prescription, which she can fax over if she likes, and she says "OK" and then never faxes it. I wonder if maybe she's hoping to call back another day and get a different pharmacist who's less strict about the law. Good luck with that though, this week I'm on every day. (Woohoo, a full week of work for the first time in ages. My bank account will love this.) They seem to think that sending the cover script makes it legal; I've told them, sure it makes it legal, but I still can't give you more than five days. "But I'm sending a cover!" "Yes, and that cover has to be for only five days." Why do some people think they're above the law?

Edit to add: It is now legal under Federal law for a doctor to utter multiple prescriptions for the same drug on the same date, with instructions not to fill it before [date a month from now], [date two months from now], etc.. This did not used to be the case. (Again, I don't know Florida pharmacy law, so I don't know if this will fly in your state; I'm pretty sure NY and NJ don't allow it due to unfilled control scripts expiring in 30 days here.) Why this is legally distinct from simply writing refills is beyond me, as it does seem to amount to the same thing. If they're going to allow that, why not allow refills in the first place?

[BeenThereDoneThat]

Shalom - thanks for the information. It really would be helpful if the doctor's office staff was actually accessible enough to find out all the details... *sigh*

[Sapphire Silk]

One thing concerns me, though. If it's a medication that can't be prescribed with refills, then it's probably a Schedule II drug... and those can't be phoned in either, except under strictly circumscribed circumstances.

Edit to add: It is now legal under Federal law for a doctor to utter multiple prescriptions for the same drug on the same date, with instructions not to fill it before [date a month from now], [date two months from now], etc.. This did not used to be the case. (Again, I don't know Florida pharmacy law, so I don't know if this will fly in your state; I'm pretty sure NY and NJ don't allow it due to unfilled control scripts expiring in 30 days here.) Why this is legally distinct from simply writing refills is beyond me, as it does seem to amount to the same thing. If they're going to allow that, why not allow refills in the first place?

I've had similar issues with hospice getting narcotic refills for patients who run out over the weekend. I have to call the doctor to fax in a prescription (North Carolina allows it), they won't take it over the phone from me (they used to, but then the state clamped down).

As for the issue of refills not before a specific date, I can answer that one. It's to address the issue of drug seeking behavior and diversion. It lets the patient know, if you run out for any reason, you will not get a refill before X date no if ands or buts.

It's a good idea, but of course has the limit that if the patient finds a doctor from a another practice, or uses a different pharmacy, they can get around this.

[BeenThereDoneThat]

Well, I'll be off this coming Thursday. If I don't get through to this doctor's office by tomorrow I'll call my primary care physician and see what they have to say about all this.

[Sapphire Silk]

Well, I'll be off this coming Thursday. If I don't get through to this doctor's office by tomorrow I'll call my primary care physician and see what they have to say about all this.

Good. Let us know how it turns out.