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Office Visit R.I.P.: Refills

09/21/2018

Especially if your treatment involves a controlled substance, your prescriber will almost certainly require an office encounter as a prerequisite to a refill. This costly, perfunctory practice should stop.

Medical providers should only require face to face encounters for legitimate clinical purposes like performing physical examination or testing they cannot accomplish via teleconference. Many patients' illnesses will require continued use of the same medication at the same dose for years. Prescribers can -- and should -- keep patients informed via electronic messaging or other media of changes in knowledge that might argue for a change in medication or dosing, of side effects the patient should watch for, and of changes in the illness that might argue for a change in treatment. The vast majority of patients can take responsibility for contacting the provider via electronic media when these things happen. The provider can then recommend the appropriate intervention, which might involve sending the patient for diagnostic testing or a face to face encounter. In many of these cases a telephone or video conference will suffice.

Logistical problems with office visits as mundane as weather, illness, road closures and even missed appointments should not interrupt necessary treatment. 

The so-called standard of care for frequency of office visits often has no basis in clinical concerns. The frequently cited annual or quarterly visits may serve only to minimize malpractice risk and allow payment of the prescriber. As for the latter matter, a different payment model might involve payment of the provider for overall responsibility or supervision of a case or a reasonable fee for reviewing the case prior to authorizing the refill, rather than the outdated payment only for procedures or encounters, .

Requiring patient and provider to jump through an unnecessary hoop does not prevent drug diversion or other prohibited activity. Medical schools train physicians to diagnose and treat illness, not to enforce the law or prevent violations. Physicians should refuse to act as drug police, a role that destroys the physician-patient relationship. Maybe pharmacists, who act as de facto "drug dealers" anyway, should assume such roles. Maybe DEA should review all prescriptions for controlled substances prior to allowing the pharmacy to dispense them.