© 2010 Roy Benaroch, MD
I don’t hang out with doctors much. They’re too whiney.
There’s always something to complain about. Medicare pay cuts. New insurance regulations. Byzantine formulary requirements. That’s why I stay out of The Doctor’s Lounge—it’s a downer. I go to work, I play with the kids and hold the babies, and all is well.
But if you’ll indulge me this once, I need to vent.
I’m being swamped with requests to write prescriptions for non-prescription drugs, and it’s a hassle, and I’m tired of it, and WHY IS THIS SOMETHING THAT I HAVE TO DO?!
Sorry about that, got carried away for a moment. Pardon a brief pause to regain my professional composure.
Now: here in the USA, there are plenty of prescription drugs, and my responsibility and professional training is to use them wisely when needed, balancing their risks and benefits, and guiding families on their safe use. I counsel, we decide, I prescribe, and the responsibility for the decision is mine. Fine.
But there is another class of medications, so-called “Over The Counter” (OTC) meds. In their wisdom, the FDA determined that any shmo can buy these. Their labels are designed to clearly explain the dosing and side effects. Sure, some of them can cause problems if used incorrectly, but they’re generally quite safe. I recommend them all the time, and I’m happy to discuss their use with families. Pharmacists can also be a great resource to discuss which OTC meds are most appropriate, and how to use them.
A new provision in the zillion-page new health care legislation allows families to spend money from their Health Savings Accounts on non-prescription medications. Fine. But the rub: they require a prescription from me.
To save a family a few bucks in taxes, my staff and I have to generate an OTC “prescription.” That means we’re responsible if there is an adverse event, and we’re responsible for making sure the dose is correct, etc. It’s a considerable amount of time to deal with the phone calls, look at the charts, document the dose, document the conversation—and, since I don’t charge for phone calls, all of this is at my expense. I suppose I could require an in-person (that is, billable) encounter before writing a prescription for a non-prescription drug—but that just compounds the stupid. Does everyone who wants to give a non-prescription drug to their child actually need to see their doctor first? Of course not.
These are my choices:
1. I could refuse to write prescriptions for OTC drugs. No expense, no added liability for me. Of course, that makes me grade-A jerkface pediatrician in the eyes of my patients.
2. I could insist on in-person, billable visits prior to writing these prescriptions. Perhaps during these encounters we could read the labels together. It will make money for my practice, but it’s a waste of everyone’s time, and will make me seem like a grade-A jerkface.
3. I could start charging for phone calls for things like this. Insurance won’t cover it (naturally), so it would be a patient expense…making me look like a, well, you-know-what.
4. I could just suck it up and have my staff handle these calls and do the work and write the damn prescriptions, eating whatever expense this causes. I could even hire a new full-time non-prescription writing nurse, to take care of this and all of the other forms I’m supposed to fill out. Perhaps I could just add these to the stack of paperwork I bring home on my days off. I’ll probably go bankrupt and insane, but I won’t seem like a grade-A jerkface.
Prescriptions for non-prescriptions are just the latest example of busy-work that pediatricians are expected to do, with a smile. Child not doing well in school? Here’s a form. You need help paying for prescription drugs? Sure—just have your doctor complete this 9 page form. Want to go to camp, or play soccer? You had to withdraw from swim class? Want to keep your natural gas flowing, even though you didn’t pay the bill? Need extra time to complete your SATs, or an explanation of why you took a certain medicine years ago prior to joining the military? It’s all forms and letters, just ask your doctor, he will be glad to do it.
Or he’s a grade-A jerkface.
OK, I’m done whining. I’ve still got the best job in the world. Thanks for listening.
Filed under: Pediatric Insider information