A friend of mine went on vacation for just a few days the other week out-of-state. She called me in a panic.
“I forgot my meds!”
“I wish I could help you out. Have you tried calling your doctor?”
“I did, and I got this weird message about needing to unblock my phone, press *87 for a callback. That was hours ago, and still no call back!”
Hmm, no callback after hours?
So I offered to call her doctor for her on a landline, got right through, and got a real phone number that she was then able to use with little trouble. However, she still had to leave a message for the physician on call, and is still sitting there, waiting patiently for a callback that may or may not come.
It got me to wondering… Shouldn’t there be a more reliable system in place for people who are taking everyday medications, but forget them when they go away? Or, inadvertantly run out of them and get them through mail-order?
The current system is one based largely on hope and trust. Hope that your doctor (or their covering physician) gets your message, and trust that they actually act on that information in a timely manner.
If the problem occurs during normal business hours on a weekday, you have good reason to believe your problem will be resolved quickly. A call will be made to the local pharmacy of wherever you’re staying, and your prescription will be ready in just an hour or two.
But what happens when it’s the weekend? Or worse, a holiday? Or even worse yet, a weekend holiday?
Then, you’re at the luck of the draw. While doctors are of course have coverage during these times too, weekends and holidays mean the doctor may not be as readily available to listen to his or her messages, then sit down and take the time to attend to them until much later… if at all. (I can’t tell you how many stories I’ve heard throughout the years of people falling through the cracks of this crazy “system.”)
There’s a much easier solution to this problem.
One Solution: A National “Emergency Prescription” Database
Pharmacies could be empowered to dispense certain prescription medications without a prescription and in very limited quantities (say, less than 3 or 4 pills). A nationwide, secure database could be created to track such prescriptions, to reduce abuse.
Here’s how it might work:
- Person is on vacation and forgets their medications. The medication is important to their daily life functioning.
- Person stops by local pharmacy to obtain a new, temporary refill for medication based upon the information the person provides.
- Person shows photo ID.
- The person’s personal information is entered into a nationwide, secure emergency prescription database and is checked for duplicates (to stop pharmacy shopping and gaining more than the maximum allotted allowance of 3 or 4 pills).
- If person checks out in the database, person is given emergency refill of 3 or 4 pills of medication. Since the person’s information is now in the emergency prescription database, they can’t get another emergency refill for at least X number of days.
- Person must pay out of pocket for emergency refill (so you don’t have to worry about insurance issues).
- Only certain medications would be available under this plan, such as antidepressants or similar medications where the risk of abuse is low and the risk of being off of them for a few days imposing significant negative side effects is high.
Another Solution: A National Prescription Database
An alternative solution to this concern is even easier, and I’m frankly surprised is not readily available.
You can already transfer “scripts” (the prescription your doctor writes) from one pharmacy to another. But in my friend’s case (it being the weekend, I guess), they said it would take 2 days to do that (she’d be home in 3, so not much point in doing that).
In this day and age, why can’t scripts be available to all pharmacies at all times?
All prescriptions written by your doctor should be scanned into a national, secure database. It is available to any authorized medical professional or pharmacist.
So when you go away on vacation and forget your meds, all the local pharmacist need do is consult this nationwide database, see your valid and active prescription, and offer you an emergency supply (even if the prescription is just expired or goes over the usual limits, given the emergency nature).
This national prescription database, not your local pharmacy’s database, would now keep track of how many pills are left on your prescription. That would also have the added benefit of cutting down on all the prescription abuse problems seen today already (such as a person taking one script, copying it, and having it filled at multiple pharmacies).
How is it that in 2012 and electronic medical records everywhere that this kind of system isn’t already in place?
After waiting all day for a call back from the doctor on call, the call came only after the pharmacy was closed for the day. Apparently some doctors have no sense that pharmacies in the U.S. generally are only open during daylight, business hours.
Some people react very badly when they miss one (much less more than one) dose of a prescribed medication. Their body — so used to getting this particular medication — freaks out, and in my friend’s case, she becomes very queasy and nauseous. She got her medications the next day when the pharmacy re-opened.
The simple answer, “Get another doctor!”, doesn’t help in situations like this. There has to be a better way. My friend’s vacation went from “Yay, vacation!” to “Yay, anxiety attack!” overnight while trying to deal with the situation.
I know, in a true emergency, there’s always the E.R. But who wants to spend hours in an overbooked and understaffed E.R. waiting for a single antidepressant pill while on vacation?
23 comments
I read this post with both astonishment and annoyance when it is written by a non prescriber. Do you wear a pager or have your cell phone on 24 hours a day to take calls from patients for alleged emergent issues? If you do, then I am surprised you write this piece without taking into account we are not in place to fix people’s lapses of judgment or just plain poor insight. If we had a pill for those matters, we’d all be out of a job.
Things happen, I respect that and do my best to help out patients who are in a jam they did not have any sizeable role in being out of meds. But, and I take true exception to this, to think I have to put aside my time out of the office and spend what can be a half hour or more to problem solve a patient misplacing meds, and it is my sole obligation to do all the work, that is just rude and dismissive of my time!
Here’s a tip for any patient who reads this and respects that we are clinicians, not 24 hour call boys who run errands when out of the office: have both the pharmacy and fax numbers, every detail to the script, and realize this little gem, if you are asking to renew a prescription that was filled within the past 2 weeks for a months supply, be prepared to have to pay for it, as the insurer will almost NOT pay for the refill early.
That is not my fault, not my problem, and stop expecting doctors to have to do everyone’s bidding at whatever time of day, irregardless of what is the request. Sheesh, what is the point of this post, Dr Grohol, create a Red Box system for meds!?
I agree with the above poster, and I’m a patient who has muddled up her meds on occasion. Doctors work very hard, and they have many patient’s wellbeing in their hands. At points the original article seemed a little condescending to prescribing physicians, though I understand I may have missed something.
The idea of a national database has its pros and cons. I would be worried about privacy issues… the kind of information shared on such a database would be very sensitive, and it would be easier for personal information to be discovered on such a database. On the other hand, the benefits would probably outweigh the negatives.
The computerized solutions that Dr. Grohol proposes are excellent and long overdue. Dr. Grohol, please send your column to Tara Parker-Pope at the NY Times. Maybe she can use it as the basis for a feature, and then we can get some real traction on the issue.
Everyone I know has been caught short at one time or another on minor, but important, scrips. Blood pressure meds, allergy meds, anti-anxiety meds, etc. Sort of crazy that the doctor would have to be bothered when the patient just needs three days of Lipitor because a snowstorm stranded them in Syracuse.
Dr. Grohol, I assume you are speaking about the prescription system and emergency meds in the USA.
I work as a part-time dispensing assistant in pharmacy in the UK, alongside a full-time Psychology degree.
In the UK, if a patient demonstrates full knowledge of the medication, strengths and doses they are on, a pharmacist can sell an emergency supply with up to 30 days worth of medication. Of course, there are exceptions to the rules (such as controlled drugs and insulin) where stricter rules are in place. However, it is up to the individual pharmacist and as it is counted as a private service, the patient will be charged for their medication. (Of course, it is £7.40 per item in England anyway).
In terms of a national database, the potential for abuse of data protection would be huge. I would not advocate this, being part of a healthcare team handling many vulnerable patients.
Oh, and Dr. Hassman, you are hardly exhibiting the patient care that you provide within your community. Whilst you shouldn’t be expected to be responsible for every forgetful patient, I do not believe Dr. Grohol was ‘pointing the finger’ at any particular profession.
Sorry, I was indeed talking about the U.S.
The problem with just putting it into the hands of pharmacists is the potential for abuse. While I completely trust a pharmacist’s professional judgment in these matters, I suspect there would still be people who would abuse such a system by going from pharmacy to pharmacy. Hence the reason for either a prescription database, or at the very least, an “emergency prescription” database to take care of any potential abuse.
I agree, there is always risk of abuse or attack when you congregate data in one place. I would hope such problems could be solved.
Dr. Hassman, I’m not sure what got you so angry, but either of my solutions would actually alleviate physicians’ workloads from this thankless task. Anyone who takes medications regularly for years (like many people on antidepressants or lithium) know exactly what their dose and brand is. They don’t need a doctor to play nanny and sign off on it when something goes awry and they — gosh forbid — act human and forget something.
John
I get concerned when non prescribing people get involved in prescription matters. Which I think most people in a selective profession are annoyed when those without the training and expertise start trying to direct the profession. How about explaining this situation that does happen with some frequency in psychiatric practice: the patient who does not show for a follow up appointment and then demands a month prescription over the phone and cops an attitude when redirected what is the standard of care. If people think that prescribing psychotropic drugs without regular follow up is appropriate, then don’t complain when you have consequences.
I think the example of this post is not fair to use as a poster child for setting up reasonable access to emergent services for running out of meds. Having had a person in a practice I worked in the past call at 1PM and demand, mind you, that we scramble to get a script written up to be picked up, after the patient finally accepted the fact that stimulant meds cannot be faxed, as she was catching a 5PM flight for a vacation, just reinforces this unspoken attitude of late in health care that the patient is always right. Yeah, if health care was a business model, but it isn’t. Filling prescriptions between appointments is not some casual affair, I wish more physicians would wake up and remember standards of care better.
Hmmm, and what would you say about benzodiazepine prescription refills by phone, eh, Dr Grohol?
This is SUCH a problem for me! I take Ativan and Effexor XR, and both are just wreak havoc on my body (not to mention mood) if I miss a dose. Our locally owned pharmacy has stayed open late for me, given me emergency doses as long as I showed the bottle with “0 refills” on it and ID. They’re amazing. But if my doctor is busy, I could just be out of luck! Last week I called three days before my meds ran out and it took him that long to get back to me. On a weekday! I hate that with controlled medications like benzos (especially with New York State law), I feel like I’m a criminal until proven innocent. I just want the medication my doctor prescribed, but I can’t have refills on those prescriptions lest I sell “extras” on some kind of black market. Thanks for addressing this! I hope it does get traction. A feature in the NYTimes would be amazing.
I agree with Dr Hassman but take issue with his assertions about patients who fail to obtain or fill a script. This will sound like a cop-out to those who don’t understand, but when this happens to me it’s usually because I am very sick. Too sick to remember even the smallest of things and too sick to get out of the house. My brain and body just aren’t working properly.
I think Dr Grishol’s proposal is overly complicated. I don’t know how things are handled in the States, but here in Australia I have done the following when caught without medication during public holidays:
1) Had someone take me to a hospital with an after hours clinic and pharmacy. Yes, you pay a lot more, but I think for good reason and it keeps people with minor complaints out of the ER.
2) Contacted my local mental health crisis team. After a quick assessment and some probing questions, I had an emergency 2 or 3 day supply of medication to tide me over until I could see a regular doctor. Free of charge! This was when I couldn’t afford to go to a clinic. I would have otherwise ended up in the ER so it was worth everyone’s while. I did have ID and a letter from my psychiatrist on hand (diagnoses, meds and their strengths, etc) which I carried for emergencies.
I had rather do that than have my private information on some centralized database for everyone to see. I have enough problems with stigma from healthcare ‘professionals’ as it is!
I find Dr. Hassman’s attitude to be appalling. It is rare to find a person who never makes a mistake, forgets to do or not to do something important, or is unable for one reason or other to function as needed, but apparently Dr. Hassman is the poster boy for perfection.
John Grohol is simply offering some ideas that might help fix a situation that both patients and physicians find distressing. Either of his suggestion may not be the final solution to the issue, but his ideas may at least get a dialogue going.
It is unfortunate that Dr. Hassman appears to be unable to put a workable solution in place for himself. It is reprehensible that he has so much contempt and so little compassion for those patients whose illnesses allow him to enjoy what is most likely a standard of living far above theirs. Perhaps he should consider another line of work.
How about people show the slightest sense of personal responsibility instead of relying on doctors and pharmacists for everything? Most of these “emergencies” could be avoided with a little bit of forethought on the part of the patient.
It is amazing how people can conclude who a person is just from a couple of paragraphs in a blog. How about this scenario, Dr Grohol, people who now email their prescription problems? Gee, I guess contemptible people do not even read those? Or, accept what is the standard of care. It is my license at risk, filling a request between appts is NOT a black and white issue.
I had difficulty reading your posts because I felt the anger jumping off the page! I believe everyone, including you, is entitled to their own opinion, but the hard part in your case is the delivery of your opinions/attacks of the author and patients. I’m shocked that you haven’t received a lot of negative responses. I wonder if you reread your posts you’d see that you come off as the type of person who gets the ‘this guy really has issues” or “he needs to be in therapy.”
I thought the same thing. I have worked with doctors and some are so wrapped up in the importance of what they do that they forget the importance of who they do it for and who they do it with. No one wants a doctor to not live their lives like everyone else, but you know going into the profession that people are CONCERNED about their health and well-being often thinking if they don’t get their medications that their bodies and minds will be out of whack. I am a pharmacy technician and am treated myself and the fear they have is valid. To constantly talk about how a patient SHOULD HAVE remembered to bring medications or they SHOULD HAVE called the doctor previously, is counterproductive. Okay yeah they SHOULD HAVE, but they didn’t and so now this is the situation. What are you who presently have the power to help going to do?
I take a very expensive drug, SEROQUEL, $21.00 per pill, I take 2 a night. I am on disability, a year now. It’s a PAIN IN THE ASS to get it from the makers Astra Zeneca through this program called the AZ & Me Program. I have to call every 2 weeks to get medicine refilled. It’s then shipped to a Psychiatrist’s Office. Every month it’s the same shit. Nobody ever remembers who signed for it and to finally track down your therapist and have them call you back takes over a week. This past December my therapist moved to a new location. The post office delivered it 3 times. No one was there to sign for it. This therapist only goes in once a week to the new location. The post office then sent it back to the AZ & Me Program. In 2011 I spent $1400 out of pocket because of all the clitches, either that are walk around unmedicated. Half of my disability is going to that damn drug Seroquel. It’s not generic and there is no substitute. God have mercy on the mentally ill. Desiree Cart Dugas
Desiree Cart Dugas, your doctor, whoever prescribed you an uninsured brand name medicine when there are other similar medications like it in the same class that ARE covered, is practicing BAD medicine. Demand to be changed immediately to another medication, even Seroquel IR, instead of Seroquel XR, or any other atypical anti-psychotic that is covered where you live. The benefit of Seroquel XR over Seroquel IR IS NOT WORTH $1400 if you are on disability!
You should only be prescribed a brand name drug that isn’t covered if a) the situation is dire where the cost justifies the benefit b) you are rich or c) where there is simply no other similar drug in its category that is covered.
Otherwise you are a victim of big-pharma and bad medicine being practiced by whatever wish-wash doctor you are seeing.
Thanks Noca!
I forgot my meds a little while ago and was away for three days. We have a service where I am (in Canada) where there’s 811 a toll-free line to talk to a nurse or pharmacist (it’s 24/7 and part of our health care system – no charge). They were able to advise me what I should do re missing doses.
My dr just always makes sure I have refills. I wouldn’t want to call him and bother him between appointments – he’s got a full enough schedule. I have on a few occasions run out and the pharmacy will usually help me (and they have a record of my past prescriptions or can phone the one that does, or they phone the dr to double check). I guess going to emergency is also an option – but that’s a pretty bad use of services unless there’s no other option.
My last comment at this thread:
I stand by my first comment at the top: to suggest some form of a national data bank for all prescriptions is basically absurd on several counts, the biggest being the risk for violations of confidentiality, and such a recommendation would lead to a response of annoyance and astonishment from any provider able to prescribe to learn non prescribers are trying to direct a clinical intervention that is both state and federal monitored.
Furthermore, I have given several examples in further comments as to situations that are not black and white as this post alludes the issue is. Maybe Dr Grohol is in no position to reply or justify, but, remember people, prescription abuse is the largest growing segment of substance abuse going on in this country today. Making it less accountable to limit access to prescriptions that have the potential for abuse is just ridiculous to consider.
And what about patients trying to email requests? Each state is coming up with their own protocols of what is clinical responsibility and accountability in using the internet for patient care. Really, you think making this a computer based system will not include email contact as an option? And then increase the responsibility to monitor a practice email account?
Once again, I read at a site for mental health care how non physicians are at least subtly trying to direct physician care diagnosing and interventions. It is not responsible, and what is unfortunate is to NOT read more providers are weighing in at posts like this, not necessarily to support my position, but to at least speak out and provide debate and expertise to what is the standard of care for issues like this.
Personally, I believe a physician providing clinical care has a responsibility to directly or have credible staff at the office contact a patient within 24 hours after a call, and should have a triage in place to make sure legitimate urgent calls are responded to sooner. And, I also believe that patients should take more responsibility in managing their meds as able, and to know the pharmacy phone and fax numbers to expedite an urgent issue be resolved. And, if you are taking controlled substances and using them responsibly, there should be zero tolerance for anyone messing with those meds. Period.
And, finally, I have to apologize to some degree to Dr Ronald Pies in challenging him in the past to not addressing comments in threads that are not labeled by a direct writer. I respect anonymous and alias titles, but, if they are then insulting and slanderous in attacking commenters who are direct and up front, it only diminishes the validity of the site who allows them. I have said this at other blogs that have unfortunately allowed such behaviors to run rampant. And, as long as there is an antipsychiatry crowd hiding behind masks, a legitimate and honest debate about mental health issues that needs to be done will not be effective. However, that said, if someone is genuinely afraid of consequences in using their name, and is being respectful in a debate, an alias is acceptable and should be given some notice in a thread.
Sorry, a bit longer than intended, but, Psych Central has an obligation to present issues and allow commentary to educate and inform while staying in the bounds of the writer’s expertise. In my opinion, that was not done here per this post. But, when people legitimately are out of meds, some process should be in place to minimize withdrawal or relapse of symptoms.
Good luck with the thread beyond.
Both of the database options will cost money to set up and operate. A full time staff would be required to verify the credentials of those needing access (every physician and pharmacy in the nation, in essence) as well as simply to keep the IT infrastructure up and running. Who exactly do you propose would pay for this?
Dr. Hassam:
I’m on here because I was looking for answers.I’ve been trying to get them from qualified doctors.I used to be a talent agent in a very large agency in Hollywood. I got calls constantly from clients between 12 midnight and 6 a.m. about dog walkers,3 a.m. Calls about a typo on a script, my favorite 4 a.m.should I wear red or black? so it happens to even
normal people like me at their jobs. I have a very strong feeling Joel that I would have received a phone call like that from you if you were a client. because they all have one thing in common the world revolves around themand how much they care less about other people.
Dr. . Hassam:
I’m on here because I was looking for answers.I’ve been trying to get them from qualified doctors.I used to be a talent agent in a very large agency in Hollywood. I got calls constantly from clients between 12 midnight and 6 a.m. about dog walkers,3 a.m. Calls about a typo on a script, my favorite 4 a.m.should I wear red or black? so it happens to even
normal people like me at their jobs. I have a very strong feeling Joel that I would have received a phone call like that from you if you were a client. because they all have one thing in common the world revolves around them and how much they care less about other people.I was diagnosed with a serious neurological issue.I had to get rid of my last quote specialist because he kept prescribing me a medicine that wasn’t working and I came to find out that the only reason he was prescribing it was because he had made a hundred fifty thousand dollars from company off promoting that drug. I’m here because my doctor has not returned my phone call for 3 days to refill a klonopin prescription that I’ve been taking for 12 years. Not because I love it but because I have to take it for my health. this is a medication that taken over a long. Of time if not taken on a regular basis could cause me serious health issues.so now I’m trying to figure out how to get someone to get me two pills for the weekend my regular prescription so I don’t have a seizure or go into convulsions. so I’m looking for solutions Joe you got any?
This thread shows why doctors show practice medicine and NOT public policy, because they have no clue. One of the best models for how to handle this without screwing up everyone’s privacy or giving government bureaucrats way too much information on you, is the Kaiser Permanente model. They have 24 hour lines with highly trained and qualified advice nurses, plus working pharmacists 7 days a week, plus they’re easy to reach and answer quickly. It’s a private sector system so no government agency to have huge cost overruns. I’ve been covered by Kaiser for 27 years in two different states and it works very well. Please, doctors, stick with your profession and let the policy professionals solve the macro problems.
We’re going through this situation right now. The difference is, my daughters physician neglected to call in her prescription. She was the last appointment of the day. She saw him May 7th and its now the 20th. Assuming that her meds would be delivered 2 two weeks after her appointment, she waited. They didn’t arrive and after checking we found that they were never called in. Now we’re about to leave for her sisters medical school graduation followed by a beach trip and she has 4 days of pills left. Getting a hold of a human at the office is impossible. She now needs the script called in to a local pharmacy. She’s never once in ten years missed a dose of her meds or a doctors appointment. The difficulty in getting this taken care of is very stressful, especially when we did our part.
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