Re: giving a non critical answer and staying off the defense

March 24, 2011

Any thoughts?

Not an IMP, dreaming of it, still a hamster on a tiny

wheel (budget cuts)

Your requirement that he come in annually for a new prescription is

perfectly reasonable. I drag these folks who want a chronic topical

medication into the office to review their illness. A significant

minority are using the medication incorrectly or no longer need the

medication.

However, requiring preventive medicine reviews and BP checks before

you'll manage his psoriasis seems very paternalistic. Why not just

document that you recommended these and that he declined?

March 24, 2011

I have people who want me to call it i n becasue the dermatologist would make them come inhuh?/:) what am I chopped liver?

Any thoughts?

Not an IMP, dreaming of it, still a hamster on a tiny

wheel (budget cuts)

Your requirement that he come in annually for a new prescription is

perfectly reasonable. I drag these folks who want a chronic topical

medication into the office to review their illness. A significant

minority are using the medication incorrectly or no longer need the

medication.

However, requiring preventive medicine reviews and BP checks before

you'll manage his psoriasis seems very paternalistic. Why not just

document that you recommended these and that he declined?

-- MD ph fax

March 24, 2011

People don't want your paternalism until they have a bad outcome. Then they say you should have done more.

A colleague of mine successfully defended against a malpractice claim from a man who came in to an appointment "just" for sinusitis but had several risk factors for CAD. When the guy keeled over dead at home a week after coming in for sinusitis and URI symptoms, his destitute family turned on the doctor. Would she have been better off calling in Amoxicillin or having him come in and discuss his risk factors? Not sure. The family's attorney argued unsuccessfully that he should have been hospitalized immediately.

Why not just document that you recommended these and that he declined?

March 24, 2011

These situations certainly should encourage us to set up Telecon charges in our practices.I agree that many stable patients probably don't need to be seen more than 1x yearly - ie stable healthy 25 yo female on thyroid medicine.

Perhaps a way around some of these call in Rx situations is to have a policy for the office such as...Prescriptions called in outside of an office visit may incur a $25, $50, $100 charge -- whatever price is worth it for you.

That way, we don't feel like we are getting taken advantage of (free care), the patient pays less than a visit, etc.On the other hand, seeing your doctor 1x yearly isn't unreasonable.Certainly, if I just needed my attorney to sign a form yearly - they are going to charge me.

Locke, MD

March 24, 2011

What would be the best way to automate this? The holy grail would be to automate all the annoying requests for freebies into something the patient fills out and requires a one click approval from the doc with attached payment.

Any IMPs out there with a great work around for this?

These situations certainly should encourage us to set up Telecon charges in our practices.

March 24, 2011

At some point I would send them "The Letter".

After repeated attempts to have you come in to be seen for a needed follow-up visit for the proper managment of your health including how it relates to your Rx meds, against my best professional advice and concerns, you remain steadfast in your insistance in not coming in for a review and follow-up visit for at the very least XYZ condition no less perhaps more that may or may not have developed since we last met face to face. A large part of my responsiblity to you as your primary care physician is the continued oversight and managment of any and all of your basic healthcare needs and potential issues. I feel uncomfortable as your doctor who is responsible for such care and ANY meds or other therapies you may need without your cooperation with such appropriate oversight and which requires your cooperation both in terms of regular visits and your best attempts at following my best professional advice. It is a well known fact

that patients who regularly refuse or otherwise resist being seen for such continuity of care visits are also quite frequently the same ones who do not comply with their doctors advice.

Therefore, I am sorry to inform you, but unders such circumstances I can no longer remain your physician. As of reciept of this letter you have 30 days to find another physician for your regular care. During those 30 days I will continue to provide for you "emergency care only". I would strongly recommend since my small practice does not have the resources of a true urgent care of ER, that is such cases your needs and interests would probably be best served by simply going immediately to such a facility as opposed to coming in to my office. Refilling your non-urgent medications is not an emergency other than by your own choice to not come in to be seen, therefore I will not be re-filling your meds if and until you come in to see me for an official documentable office visit which is in both of our mutual best interests. I strongly recommend that you contact your insurance carrier or the local county medical society to start making

arraignments to have another well qualified physician continue to provide for your healthcare needs.

I am sorry that things have come to this, but at this time I can see no other alternative but to discontinue our professional relationship because of your continued insistance in not cooperating with your own healthcare needs and managment. I wish you all the best.

In Your Good Health,

Dr. Tough Ass

Send the darn thing Certified and Return Reciept and be done with this moron as he is a lawsuit waiting to happen. Document the hell out of these last few annoying phonecalls and encounters and be done with him.... That or like one or two of our similar long term uncooperative patients, this guy will return on your doorstep with problems out his ears and wonder what to do and why you were not there to take care of them.... It complete BS and should not be tolerated. This person is a short sighted selfish and immature bully and simply wants to get their way with you and has no interest in establishing a real honest cooperative doctor patient professional relationship where you actually care for their care... and that is your personal business model and professional best opinion for all patients not just him, it is even safe under "equal treatment" kind of rules. He has abondoned himself as a patient so you no longer have an ethical

responsibility to him. Ditch 'em and move on....

To: Sent: Thu, March 24, 2011 10:24:55 AMSubject: Re: giving a non critical answer and staying off the defense

These situations certainly should encourage us to set up Telecon charges in our practices.I agree that many stable patients probably don't need to be seen more than 1x yearly - ie stable healthy 25 yo female on thyroid medicine.Perhaps a way around some of these call in Rx situations is to have a policy for the office such as...Prescriptions called in outside of an office visit may incur a $25, $50, $100 charge -- whatever price is worth it for you.That way, we don't feel like we are getting taken advantage of (free care), the patient pays less than a visit, etc.On the other hand, seeing your doctor 1x yearly isn't unreasonable.Certainly, if I just needed my attorney to sign a form yearly - they are going to charge me. Locke, MD

March 24, 2011

I think you are on to something here,maybe an CRM program that integrates with paypal and an internet telephone service. ( there is one in the google app marketplace) .I did run into it a week or so ago..

off on an app hunt...

What would be the best way to automate this? The holy grail would be to automate all the annoying requests for freebies into something the patient fills out and requires a one click approval from the doc with attached payment.

Any IMPs out there with a great work around for this?

These situations certainly should encourage us to set up Telecon charges in our practices.

-- Sangeetha

March 24, 2011

So here is a template for support issues with a certain companyThere are several drop down boxes for case type. so setting up a support desk/ zendesk kind of situation. which intergrates with a telephone call logging crm..

much to think about...Look at the bottom line

Contact Information

Customer

Practice SANGEETHA MURTHY INC

First Name

Last Name

Email

Phone

Case Details

Case Type

Cannot login because user or customer account is locked Enrollment for electronic claim, ERA, and eligibility services Electronic claims setup, rejections, or troubleshooting Missing electronic remittance advice (ERA) reports Paper claims setup or troubleshooting Appointment scheduling or encounter forms usage Reports, data import/export, or integrations Invoices or statements for your Kareo account Check or payments on your Kareo account Request for non-physician (mid-level) provider discount Account cancellation or provider deactivations System performance or connectivity issues Apparent product defect or bug All other questions or issues

Instructions

Enter the practice (if applicable), user name and email address (if applicable), and a concise description of the system performance or connectivity issues you are currently experiencing.

Subject

Description

Support policy

You do not require a support plan to submit a case for this type of issue. COMPANY XXX will review and respond to this case.

I think you are on to something here,maybe an CRM program that integrates with paypal and an internet telephone service. ( there is one in the google app marketplace) .I did run into it a week or so ago..

off on an app hunt...

What would be the best way to automate this? The holy grail would be to automate all the annoying requests for freebies into something the patient fills out and requires a one click approval from the doc with attached payment.

Any IMPs out there with a great work around for this?

These situations certainly should encourage us to set up Telecon charges in our practices.

-- Sangeetha

March 24, 2011

" To insure the best quality care for my patients, it is in the patient's best interest to come for a visit after 30 days of being put on new ADHD medication. If the patient is stable and doing well on the medication, then the next visit wouldn't need to be for XXX days and I will provide you with a prescription for enough medication for that time. " If the mom is accusing you of wanting money, then it is probably not a good fit.

Patient with ADHD -- doing well on new medication started last month as per mom on the phone. My practice has been to see the patient 30 days after new meds. Mom is objecting and wants it over the phone. I'm getting lots of patients transferring from doctors who did a ton of refills over the phone. I simply don't feel comfortable with that. I want to see this teen. Then I get accused of just wanting money!

What have others answered with this kind of scenario?

(I have given lots of care to this family over the phone as well but this doesn't feel comfortable. Nor do I want to get baited with " Dr. S would have done it. " Which may speak more to the other office being overstretched than good medical practice.)

--

Pratt

Oak Tree Internal Medicine, PC

2301 Camino Ramon, Suite 290

San Ramon, CA 94583

p.

f.

c.

www.prattmd.info

March 24, 2011

Myria, Tell them you are not " Doctor S! " and I will cut and paste

my refill policy below. I send this out to all patients who push the

limits with me:

(Have something you can say - a one-liner or send like this

info sheet by email so you DO NOT WASTE your time getting

into a conversation about this!)

Refill Requests Information Sheet

Pamela L. Wible, MD

What's the deal with refills?

Refills are granted at the time of your office visit and not in

between visits. Please DO NOT have your pharmacist call the

office asking for a refill. When you are running low on your

medication it is a reminder that you are probably due for

an office visit. I prescribe enough medication to last until

your next office visit.

How much medication can I get at the time of my appointment?

If you have no issues and you are stable on your medication you

can usually get a year supply (thyroid and birth control pills usually).

If you have an ongoing medical issue that is stable you can often get

a 3-6 month supply (high blood pressure pills, for example). If you

have issues that are not under control then you usually need to return

every 1-3 months for medication and evaluation (diabetes, for example).

Some people who have dangerously out of control issues have to come

back in 1-2 weeks. So the moral of the story is to get your health issues

under control and make sure you ask for your refills at the time of your

office visit so you are not surprised when the pharmacist says " Sorry,

you have run out of medication. "

Why can't I just call when I'm on my last pill like at other doctor's offices?

The average office is inundated with refill requests and they often need to

hire lots of staff to handle the sheer volume of refill requests. Thirty percent

of the phone calls to the average office are related to refill requests. Another

20% of calls are second calls in the same day from the same person who did

not get their call returned. " It's 4:45 and nobody called me back! I just took

my last pill! Help! "

Why is it my responsibility to keep track of my medication?

Your physician usually has over 2500 patients to keep track of at the average

office. I have approximately 350. Either way it is impossible for physicians to

keep track of your medication. It is also hard on the pharmacists if you wait

till the last minute to ask for a refill. Please keep track of your medication

so

you can ask in advance of using your last pill. It is best to schedule an

appointment while you still have a week's supply left.

What if I know you wrote me a longer supply than the pharmacists says

I have left?

Tell the pharmacist to pull the " hard copy " and make sure that the

pharmacist entered it in the computer correctly.

Anything else I can do to make things easier?

If you take a look at your prescriptions and try to get them renewed on the

same cycle such as every 3,6,9 or 12 months then you will have them all in

sequence and easy to remember the renewal date on all of them. Ask each

time you go to the pharmacy to make sure you know when you will run out.

Keep that list in your wallet so you will know when you come to your

appointments.

What if I'm in a pinch? Are there exceptions?

Pharmacists will usually give you a 3 day supply to tide you over in an

emergency. I make exceptions for situations in which you have had an

emergency or are out of town. I also do not hold patients with traumatic

brain injury or dementia to the same standards as those with normal

cerebral function.

I hope this was helpful! Thanks for being proactive and helping me have

an efficient and streamlined medical practice.

>

> Patient with ADHD -- doing well on new medication started last month as per

mom

> on the phone. My practice has been to see the patient 30 days after new

meds.

> Mom is objecting and wants it over the phone. I'm getting lots of patients

> transferring from doctors who did a ton of refills over the phone. I simply

> don't feel comfortable with that. I want to see this teen. Then I get

accused

> of just wanting money!

> What have others answered with this kind of scenario?

> (I have given lots of care to this family over the phone as well but this

> doesn't feel comfortable. Nor do I want to get baited with " Dr. S would have

> done it. " Which may speak more to the other office being overstretched than

good

> medical practice.)

>

March 25, 2011

I interview all new patients; and do not charge for that visit to make sure we are all on the same page. It saves lots of time in the long run. That way I can find a polite way to not accept the ones who tell you about all the bad doctors they have had and how they hope I will be the one good one who does everything they ask, and all the chronic pain multiple doc folks, etc. I review my refill policy at that visit, and that way when these things happen I can say "as I told you on our first visit..." or else "I can understand that you didn't really understand what I meant what I told you about our refill policy. However....." And about Dr S? I always agree: "Yes, I have heard that is what Dr S does..." in a bland voice implying that I am carefully not being overtly critical of

this totally bad practice. (This is honest...I just heard it, didn't I?) You will have to work out your own way to finesse this. Just don't let them talk you into something you don't want to do, because you will regret it. Joanne Holland DVM/MD Drain, Oregon

Patient with ADHD -- doing well on new medication started last month as per mom on the phone. My practice has been to see the patient 30 days after new meds. Mom is objecting and wants it over the phone. I'm getting lots of patients transferring from doctors who did a ton of refills over the phone. I simply don't feel comfortable with that. I want to see this teen. Then I get accused of just wanting money!

What have others answered with this kind of scenario?

(I have given lots of care to this family over the phone as well but this doesn't feel comfortable. Nor do I want to get baited with "Dr. S would have done it." Which may speak more to the other office being overstretched than good medical practice.)

March 25, 2011

In this sort of situation, I will find a best practice reference and let the patient have that to read.

Patient with ADHD -- doing well on new medication started last month as per mom on the phone. My practice has been to see the patient 30 days after new meds. Mom is objecting and wants it over the phone. I'm getting lots of patients transferring from doctors who did a ton of refills over the phone. I simply don't feel comfortable with that. I want to see this teen. Then I get accused of just wanting money!

What have others answered with this kind of scenario?

-- Graham Chiuhttp://www.compkarori.co.nz:8090/Synapse - the use from anywhere EMR.

March 25, 2011

As bad as the patients can be about not coming in at appropriate times, is as

bad as we can be at seeing them as adversaries instead of partners.

Any communication with them must be straight forward with the focus on proper

medical care, not just what is easy. If done correctly, you will grow your

practice with like minded patients, while the others who instead prefer to use

your skills for their own means, will weed themselves out.

Partnering in their care, as opposed to dictating it, while following proper

medical standards of care. It may be tough, but it is definitely doable!

Horvitz, D.O?

stown, NJ

Founder of the Institute for Medical Wellnesx

> >

> >>

> >> What would be the best way to automate this? The holy grail would be to

> >> automate all the annoying requests for freebies into something the patient

> >> fills out and requires a one click approval from the doc with attached

> >> payment.

> >>

> >> Any IMPs out there with a great work around for this?

> >> These situations certainly should encourage us to set up Telecon charges

> >> in our practices.

> >>

> >

> > --

> >

> > Sangeetha

> >

>

> --

>

> Sangeetha

>

March 25, 2011

I use jotform.com for my 'virtual visits'... this would include refills of this type. It is integrated with PayPal- you can set it up that it does not complete until they pay. You can have branching questions. They offer secure form submission. I also use it for my medical history form, ROS and demographics forms- my patients submit them all online prior to their appointment. I love that I can print to Word then cut an paste into my EMR.CarlaTo: Sent: Thu, March 24, 2011 9:58:48 AMSubject: Re: giving a non critical answer and staying off the defense

So here is a template for support issues with a certain companyThere are several drop down boxes for case type. so setting up a support desk/ zendesk kind of situation. which intergrates with a telephone call logging crm..

much to think about...Look at the bottom line

Contact Information

Customer

PracticeSANGEETHA MURTHY INC

First Name

Last Name

Email

Phone

Case Details

Case Type

Cannot login because user or customer account is lockedEnrollment for electronic claim, ERA, and eligibility servicesElectronic claims setup, rejections, or troubleshootingMissing electronic remittance advice (ERA) reportsPaper claims setup or troubleshootingAppointment scheduling or encounter forms usageReports, data import/export, or integrationsInvoices or statements for your Kareo accountCheck or payments on your Kareo accountRequest for non-physician (mid-level) provider discountAccount cancellation or provider deactivationsSystem performance or connectivity issuesApparent product defect or bugAll other questions or issues

Instructions

Enter the practice (if applicable), user name and email address (if applicable), and a concise description of the system performance or connectivity issues you are currently experiencing.

Subject

Description

Support policy

You do not require a support plan to submit a case for this type of issue. COMPANY XXX will review and respond to this case.

I think you are on to something here,maybe an CRM program that integrates with paypal and an internet telephone service. ( there is one in the google app marketplace) .I did run into it a week or so ago..

off on an app hunt...

What would be the best way to automate this? The holy grail would be to automate all the annoying requests for freebies into something the patient fills out and requires a one click approval from the doc with attached payment.

Any IMPs out there with a great work around for this?

These situations certainly should encourage us to set up Telecon charges in our practices.

-- Sangeetha

March 25, 2011

Looks like jotform.com sends data back using regular email.Â Do you have a HIPAA warning on each form before collecting data from patient? From: [mailto: ] On Behalf Of Carla GibsonSent: Friday, March 25, 2011 12:31 AMTo: Subject: Re: giving a non critical answer and staying off the defense I use jotform.com for my 'virtual visits'... this would include refills of this type. It is integrated with PayPal- you can set it up that it does not complete until they pay. You can have branching questions. They offer secure form submission. I also use it for my medical history form, ROS and demographics forms- my patients submit them all online prior to their appointment. I love that I can print to Word then cut an paste into my EMR.Carla To: Sent: Thu, March 24, 2011 9:58:48 AMSubject: Re: giving a non critical answer and staying off the defense So here is a template for support issues with a certain company There are several drop down boxes for case type. so setting up a support desk/ zendesk kind of situation. which intergrates with a telephone call logging crm.. much to think about... Look at the bottom line Contact InformationCustomerSangeetha Murthy IncPractice[sANGEETHA MURTHY INC \/]First NameSANGEETHALast NameMURTHYEmailsangeethamurthy@...Phone Case Details Case Type[Cannot login because user or customer account is locked \/] InstructionsEnter the practice (if applicable), user name and email address (if applicable), and a concise description of the system performance or connectivity issues you are currently experiencing.Subject[ ]Description Support policyYou do not require a support plan to submit a case for this type of issue. COMPANY XXX will review and respond to this case.[submitting...] I think you are on to something here, maybe an CRM program that integrates with paypal and an internet telephone service. ( there is one in the google app marketplace) .I did run into it a week or so ago.. off on an app hunt... What would be the best way to automate this? The holy grail would be to automate all the annoying requests for freebies into something the patient fills out and requires a one click approval from the doc with attached payment. Any IMPs out there with a great work around for this? These situations certainly should encourage us to set up Telecon charges in our practices. -- Sangeetha-- Sangeetha

March 26, 2011

You can direct the patient to the secure version of Jotform and have secure form submission. You can elect to have an email sent to you or not, or have just a few fields from the form sent to you. I do the latter so I'm aware of a new form coming in then I go to the site to review and download it. I believe the way I have it set up is secure enough. Patients have the choice of printing the forms from my website also but most choose to do it online.With that said, I always wonder what is "secure enough" and do plan to see if I can discuss security a bit further with the jotform folks... I have questions re: security with appointment quest, basic Yahoo/gmail servers, Updox and every other technological tool so many of us use. I would like companies like jotform and

appointmentquest to say outright that they are HIPAA compliant in regard to security. I think technology security would be a great topic for camp... even though I'm not likely to make it there this year.CarlaTo: Sent: Fri, March 25, 2011 8:06:55 AMSubject: RE: giving a non critical answer and staying off the defense

Looks like jotform.com sends data back using regular email. Do you have a HIPAA warning on each form before collecting data from patient? From: [mailto: ] On Behalf Of Carla GibsonSent: Friday, March 25, 2011 12:31 AMTo:

Subject: Re: giving a non critical answer and staying off the defense I use jotform.com for my 'virtual visits'... this would include refills of this type. It is integrated with PayPal- you can set it up that it does not complete until they pay. You can have branching questions. They offer secure form submission. I also use it for my medical history form, ROS and demographics forms- my patients submit them all online prior to their appointment. I love that I can print to Word then cut an paste into my EMR.Carla

To: Sent: Thu, March 24, 2011 9:58:48 AMSubject: Re: giving a non critical answer and staying off the defense So here is a template for support issues with a certain company There are several drop down boxes for case type. so setting up a support desk/ zendesk kind of situation. which intergrates with a telephone call logging

crm.. much to think about... Look at the bottom line Contact InformationCustomerSangeetha Murthy IncPractice[sANGEETHA MURTHY

INC \/]First NameSANGEETHALast NameMURTHYEmailsangeethamurthy@...Phone Case Details Case Type[Cannot login

because user or customer account is locked \/] InstructionsEnter the practice (if applicable), user name and email address (if applicable), and a concise description of the system performance or connectivity issues you are currently experiencing.Subject[ ]Description Support policyYou do not require a support plan to submit a case for this type of issue. COMPANY XXX will review and respond to this case.[submitting...] I think you are on to something here, maybe an CRM program that integrates with paypal and an internet telephone service. ( there is one in the google app marketplace) .I did run into it a week or so ago.. off on an

app hunt... What would be the best way to automate this? The holy grail would be to automate all the annoying requests for freebies into something the patient fills out and requires a one click approval from the doc with attached payment. Any IMPs out there with a great work around for this? These situations certainly should encourage us to set up Telecon charges in our practices. -- Sangeetha-- Sangeetha

March 26, 2011

Thanks carla , that looks like a good resource

You can direct the patient to the secure version of Jotform and have secure form submission. You can elect to have an email sent to you or not, or have just a few fields from the form sent to you. I do the latter so I'm aware of a new form coming in then I go to the site to review and download it. I believe the way I have it set up is secure enough. Patients have the choice of printing the forms from my website also but most choose to do it online.

With that said, I always wonder what is " secure enough " and do plan to see if I can discuss security a bit further with the jotform folks... I have questions re: security with appointment quest, basic Yahoo/gmail servers, Updox and every other technological tool so many of us use. I would like companies like jotform and

appointmentquest to say outright that they are HIPAA compliant in regard to security. I think technology security would be a great topic for camp... even though I'm not likely to make it there this year.Carla

To:

Sent: Fri, March 25, 2011 8:06:55 AMSubject: RE: giving a non critical answer and staying off the defense

Looks like jotform.com sends data back using regular email. Do you have a HIPAA warning on each form before collecting data from patient?

From: [mailto: ] On Behalf Of Carla Gibson

Sent: Friday, March 25, 2011 12:31 AMTo:

Subject: Re: giving a non critical answer and staying off the defense

I use jotform.com for my 'virtual visits'... this would include refills of this type. It is integrated with PayPal- you can set it up that it does not complete until they pay. You can have branching questions. They offer secure form submission. I also use it for my medical history form, ROS and demographics forms- my patients submit them all online prior to their appointment. I love that I can print to Word then cut an paste into my EMR.

Carla

To:

Sent: Thu, March 24, 2011 9:58:48 AMSubject: Re: giving a non critical answer and staying off the defense So here is a template for support issues with a certain company

There are several drop down boxes for case type. so setting up a support desk/ zendesk kind of situation. which intergrates with a telephone call logging

crm.. much to think about...

Look at the bottom line Contact Information

Customer

Sangeetha Murthy IncPractice[sANGEETHA MURTHY

INC \/]First NameSANGEETHALast Name

MURTHYEmailsangeethamurthy@...

Phone

Case Details

Case Type[Cannot login

because user or customer account is locked \/]

InstructionsEnter the practice (if applicable), user name and email address (if applicable), and a concise description of the system performance or connectivity issues you are currently experiencing.

Subject[ ]Description

Support policyYou do not require a support plan to submit a case for this type of issue. COMPANY XXX will review and respond to this case.

[submitting...]

I think you are on to something here, maybe an CRM program that integrates with paypal and an internet telephone service. ( there is one in the google app marketplace) .I did run into it a week or so ago..

off on an

app hunt...

What would be the best way to automate this? The holy grail would be to automate all the annoying requests for freebies into something the patient fills out and requires a one click approval from the doc with attached payment.

Any IMPs out there with a great work around for this? These situations certainly should encourage us to set up Telecon charges in our practices.

-- Sangeetha

March 26, 2011

ditto

To: Sent: Thu, March 24, 2011 9:43:09 AMSubject: RE: giving a non critical answer and staying off the defense

Personally, I wonâ€™t refill anything if patient not seen in over 12 months.

From: [mailto: ] On Behalf Of Sent: Thursday, March 24, 2011 9:38 AMTo: Subject: Re: giving a non critical answer and staying off the defense

I had a very similar experience regarding refills I wanted to ask the group--patient I've only seen a few times, I took over for a doctor that had left the practice. Only gets steroid cream for his psorasis. I have not seen him since 2009 and called to get a refill for the bethamethasone cream. I think he is 51. Refuses colonoscopy and most preventative medicine. I explained that its important to check in on at least a yearly basis to review basic health stuff and for insurance/general liability purposes he should be seen yearly.

Despite denying the refill, I got another message yesterday saying "he has been taking the med for 25 years and wants me to reconsider."

At this point the easy thing is to just refill it to end the situation, since if I deny it, he likely will just continue to complain-and I will get another one in a line of endless messages to my already growing list of call-backs (since nobody wants to come in).

But I need the opportunity to review his bp, review or explain preventative med, etc etc

I am going to tell him "I did not refill this for you for 25 years, I am sorry but if all you want is a refill, you should seek another doc for that. I have to evaluate you just in case anything has changed."

Any thoughts?

Not an IMP, dreaming of it, still a hamster on a tiny wheel (budget cuts)

March 26, 2011

yeah, everyday, I get better at saying, If you want me to open your chart , you need to come in..and now its such a nobrainer... I wonder why I ever felt pressured, had one today with appt at 10.45 turns up at 12.30,( which is already booked) wants me to see him, because per my receptionist " he just wants an rx "

If I wanted to feel rushed , I would have worked for somebodyelse!!!and as some wise soul said dont do " this one time " what you never want to do..

ditto

To:

Sent: Thu, March 24, 2011 9:43:09 AMSubject: RE: giving a non critical answer and staying off the defense

Personally, I won’t refill anything if patient not seen in over 12 months.

From: [mailto: ] On Behalf Of

Sent: Thursday, March 24, 2011 9:38 AMTo:

Subject: Re: giving a non critical answer and staying off the defense

I had a very similar experience regarding refills I wanted to ask the group--patient I've only seen a few times, I took over for a doctor that had left the practice. Only gets steroid cream for his psorasis. I have not seen him since 2009 and called to get a refill for the bethamethasone cream. I think he is 51. Refuses colonoscopy and most preventative medicine. I explained that its important to check in on at least a yearly basis to review basic health stuff and for insurance/general liability purposes he should be seen yearly.

Despite denying the refill, I got another message yesterday saying " he has been taking the med for 25 years and wants me to reconsider. "

At this point the easy thing is to just refill it to end the situation, since if I deny it, he likely will just continue to complain-and I will get another one in a line of endless messages to my already growing list of call-backs (since nobody wants to come in).

But I need the opportunity to review his bp, review or explain preventative med, etc etc

I am going to tell him " I did not refill this for you for 25 years, I am sorry but if all you want is a refill, you should seek another doc for that. I have to evaluate you just in case anything has changed. "

Any thoughts?

Not an IMP, dreaming of it, still a hamster on a tiny wheel (budget cuts)

-- Sangeetha

March 26, 2011

I did. Good that I did. But I'm soooooooooooo tired of hearing......"the doctor down the road would....." or "all the other doctors do it".

I like the observation "it's a warning sign" of not being a good fit. I may indeed do a 15 minute phone visit to start screening out the won't fit patients in advance cuz there sure are a lot of doctor shoppers.

To: Sent: Thu, March 24, 2011 9:39:57 AMSubject: RE: giving a non critical answer and staying off the defense

Please stick to your guns! Many of us are trying to do the right thing too, but when other practices let them get away with it, weâ€™re seen as the bad guys. Itâ€™s great that you have standards.

We didnâ€™t go into this field to be uncomfortable; itâ€™s a warning flag. You are right to set rules and practice safe and effective medicine as you see fit.

IMHO

TSLittle, MD

From: [mailto: ] On Behalf Of MyriaSent: Thursday, March 24, 2011 8:32 AMTo: practiceimprovement1 Subject: giving a non critical answer and staying off the defense

Patient with ADHD -- doing well on new medication started last month as per mom on the phone. My practice has been to see the patient 30 days after new meds. Mom is objecting and wants it over the phone. I'm getting lots of patients transferring from doctors who did a ton of refills over the phone. I simply don't feel comfortable with that. I want to see this teen. Then I get accused of just wanting money!

What have others answered with this kind of scenario?

(I have given lots of care to this family over the phone as well but this doesn't feel comfortable. Nor do I want to get baited with "Dr. S would have done it." Which may speak more to the other office being overstretched than good medical practice.)

March 26, 2011

To: Sent: Fri, March 25, 2011 7:46:21 PMSubject: Re: giving a non critical answer and staying off the defense

yeah, everyday, I get better at saying, If you want me to open your chart , you need to come in..

and now its such a nobrainer... I wonder why I ever felt pressured, had one today with appt at 10.45 turns up at 12.30,( which is already booked) wants me to see him, because per my receptionist " he just wants an rx"

If I wanted to feel rushed , I would have worked for somebodyelse!!!

and as some wise soul said dont do "this one time" what you never want to do..