drawing the line

[Guest guest]

With the loss (imminent ? ... or fait accompli ?) loss of Larry Lyon,

this list-serve needs a grouchy voice, and every once in a while I

feel one of those rising out of my waddle ... Today, a series of 4 or

5 phone messages culminated in another prescription (for Allegra, no

less) issued to another pharmacy, in a city just across the area-code

border-line from me ... I am lucky to have a cheap long-distance phone

rate, but the time/hassle of making decisions, reviewing charts, and

documenting actions for prescriptions is un-compensated work.

I tell all patients to bring the brown paper bag full of their pill-

bottles to every visit, and scan the labels for the " no more refills

coming " warnings ... Some patients just don't learn, and those are

usually the patients on 8 prescription drugs. We deal with the Lipitor

and the Lisinopril and the Lantus, but they forgot about the Paxil

running-low at home ... that phone call comes back about 3 weeks

later, which is close to the limits of my memory about that last

visit, but then about 6 weeks out comes the phone call about Allegra.

How much free work can a doctor do for a patient, between visits,

before that doctor starts to feel abused and resentful ? ... Any

patient can walk on over to the all-night grocery store and buy a

bottle of Claritin or Zyrtec, without bothering the doctor's office,

but to cash in on his insurance deal, a patient gets the pharmacist to

FAX the first salvo to the doctor's office ... Way too often, this

will lead to a requirement to get " prior authorization " from the

patient's new health insurance company, to prove that the only

antihistamine that will let that patient live in harmony with those 3

pet cats is the one that takes a prescription ...

I am getting close to the point of declaring that every prescription,

every note for a boss, every handicapper parking form, etc. has to be

composed / filled-out / phoned-in during a face-to-face visit , for

which there will be a charge ...