Prescribing medication from a patient's and physician's perspective

At least a few times a year, I am asked to prescribe antibiotics to people who are not my patients. From my point of view, there is only one answer that makes sense here – no. I have the same reaction when patients call me for a refill or advice when I have not seen them in a year or two. The patient may feel that I will refill their heartburn medicine indefinitely without an office visit, but I won’t. Once I hit the refill button, I am now totally responsible as the doctor.

The patient’s perspective

“I’ve been on the same medicine for ten years, and all I need is a refill. I feel fine.”

“I do not want to take time off work for an unnecessary appointment.”

“Why should I pay a copay when all I need is a refill? Sounds like a ripoff.”

The physician’s perspective

No refill until I verify that there are no concerning symptoms. A routine “heartburn patient” may have developed some swallowing difficulties, which could signal a serious medical condition.

The patient may not need the same dosage of the medicine.

The patient may not need medicine at all.

The patient may be on new medications, which might impact on the decision to refill the heartburn drug.

The patient may be overdue for a screening colonoscopy.

The patient may have general medical issues and needs to be encouraged to follow up with the primary care physician.

It might be tempting for one of our staff to ask me for antibiotics because “I have another UTI.” My secretary might hope that with one phone call, I can save her time and money. While she may be an able secretary, she may be a lackluster diagnostician. Many of my own patients come to my office “because their diverticulitis is back.” While their symptoms may remind them of their first episode of “diverticulitis” last year, often, the actual medical evidence supporting the original diagnosis is rather thin. I can’t count how many of these patients have never had diverticulitis.

Prescribing medication is a serious responsibility. It’s not an act that should be casually done with a stroke of a pen, or these days, with a stroke of a key. Wouldn’t you want all the odds to be in your favor?

Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower.