Comments on Scalpel or Sword?: Medicare Med Refills in the ER

I ended up in a discussion with my grandmother ove...

2008-12-09T00:01:00.000-06:00

I ended up in a discussion with my grandmother over this. She has a habit of waiting until she is on deaths doorstep before going to see a doctor. She has been very sick since thanksgiving and we finally managed to convince her to call a doctor. I gave her the number for my doctor and she called a few others as well (not sure how many she called since when I picked her up to take her to the doctor she was pretty confused). Only one small clinic (I think it was actually a branch of a larger main clinic) took Medicare and tricare which made her very upset. I think it is primarily the privately owned practices where I live that have had to stop taking new Medicare patients. This leaved people like (my grandmother) unable to find someone who will see them when they get sick.

Update: Sad to report that my local ER did not giv...

2008-12-06T13:25:00.000-06:00

Update: Sad to report that my local ER did not give me my 1 day refill of dilaudid but instead the clinician jotted down some numbers on my chart (I believe it was 30590) then went to talk to the security guard.

Grrr. I was sent home with an Rx for ibuprofen.

med refills done from the ER???? that is absurd, u...

2008-12-06T08:38:00.000-06:00

med refills done from the ER???? that is absurd, unless it is a very good reason behind it! the ER is for Emergencies, life or death situations, broken bones, trauma, in labor, etc,.. if I worked in the ED I would make the patient with the refill request wait for so long, that they get disgusted and go to their own doctor to get it!!! that's just my opinion, Stacy...

Sometimes I'll write a Tylenol or Motrin prescript...

2008-12-06T03:05:00.000-06:00

Sometimes I'll write a Tylenol or Motrin prescription just to document the proper dose I want a parent to give their child. The dosage charts on the bottles aren't always accurate since the medications are supposed to be based on weight rather than age.

Did everyone catch that, according to an AMA surve...

2008-12-05T23:07:00.000-06:00

Did everyone catch that, according to an AMA survey of graduating senior medical students, only 2% are planning to go into primary care? Many internal medicine and family practice residencies cannot fill their spots with US graduates. Even people who are going into internal med are frequently using it as a path to some specialty.
The easy, obvious fix is to implement increased reimbursement for primary care services (office visits, primarily) with a cost of living increase annually and to decrease administrative burden. After a few years, a lot more medical students would be willing to go into primary care.
The current "solutions" being proposed are rather pathetic. Partial loan reimbursement for X years of practice (almost never worth enough to justify deferring fellowship training) and medical schools "emphasizing primary care" to frosh medical students (doesn't survive first contact with reality) are ineffective.

Not a refill, but at the ER last night (took the 3...

2008-12-05T19:09:00.000-06:00

Not a refill, but at the ER last night (took the 3-year-old in because half of her face started to swell up), one of the two prescriptions I was given was for Children's Tylenol.

At first I couldn't figure out why I was given a scrip for something I could buy OTC for maybe 1/2 my copay (which is $10 for generics), then I remembered something on Nurse K's blog about Medicaid co-pays being tiny.

Still, I don't see a reason to encourage something like that, and it's exactly what the doctor was doing, IMO. I certainly didn't ask for the Rx; in fact I told the nurses I'd given her acetaminophen at home. (So I was given a scrip not just for something available OTC, but for something I already had.)

Okay, so I was going to suggest Urgent Cares, too,...

2008-12-05T15:37:00.000-06:00

Okay, so I was going to suggest Urgent Cares, too, but apparently that's not an option, so I'm a little confused as to where these places fit into the medical schema.

That's where I went when between PMDs, but I don't have any chronic conditions that need following.

Don't encourage people to come to urgent care for ...

2008-12-05T14:56:00.000-06:00

Don't encourage people to come to urgent care for their primary care--that's not what we do. We do not see people on an ongoing basis to manage their hypertension, cholesterol, heart disease, etc. We especially do not want people requesting refills of their Percocet for their years of back pain. They need a primary for ongoing management of chronic problems. Now, whether they can get that or not is a whole other issue.

I really believe that it's going to take our whole system breaking down to result in any kind of change. The blame for this is on many levels--ridiculous reimbursements by government programs, us docs ordering too many tests for fear of being sued for missing something, patients wanting an MRI at the first sign of a knee or shoulder injury, etc.

Ugh. I would have never gone to medical school if I knew what the state of healthcare would be now.

Thanks Scapel, I went, Im better now.

2008-12-05T14:27:00.000-06:00

Thanks Scapel, I went, Im better now.

With the proliferation of Urgent Care centers and ...

2008-12-05T12:42:00.000-06:00

With the proliferation of Urgent Care centers and nurse practitioner in a box locations around the country, people might want to consider going there for BASIC primary care. Obviously, a board-certified internist or family practice MD is going to have way more experience/knowledge than an NP, but seeing somebody is better than seeing nobody. I'm a pharmacist and I see all kinds go to an ED for routine stuff that can be done by a PCP. I try to encourage pts NOT to use the ED as a primary care office, as it is not nearly convenient for them (longer waits) and the ED staff (greater acuity of triages to worry about). Oh, and don't get me started on people calling in refills by pill shape and color. I know what a vast majority of pills look like, but that's why we have prescription numbers on the bottle!!

jeez at least they know the name of their meds...w...

2008-12-05T07:38:00.000-06:00

jeez at least they know the name of their meds...what i hear is it's a little white pill and i used to take two but now i take one don't you know what it is? or it's in my medical records you go look it up. it should be patient's entitlements not rights because rights imply responsibility and i'm sure as hell not seeing any of that

Yes.

2008-12-05T00:34:00.000-06:00

Yes.

Hey scapel, maybe you could give me some friendly ...

2008-12-04T23:34:00.000-06:00

Hey scapel, maybe you could give me some friendly advice...

I had a CT scan yesterday, with oral and Intravenous contrast. Last night I started to get itchy. This morning I had a rash over pretty much all of my body. Called Doc, he said to take benadryl. Ive taken my 3rd dose today and nothing is happening. The rash is now on my face and very itchy...
Would a trip to the ER be resonable?

1 refill?Please, I need one:8 mg dihydromorphinone...

2008-12-04T22:34:00.000-06:00

1 refill?

Please, I need one:

8 mg dihydromorphinone Sig fid x3d

That should be a good weekend.

Google: My nearest ER

I guess I am lucky up here since I don't know of a...

2008-12-04T09:01:00.000-06:00

I guess I am lucky up here since I don't know of any internists or family docs who don't participate in Medicare.

I don't have a problem giving people their med ref...

2008-12-04T08:58:00.000-06:00

I don't have a problem giving people their med refills - for a few days until they get into their regular physician. If they keep coming back, then they get one day's refill per visit.
If people want to wait three hours in the ED for a med refill every day of the week, I'm there for them.