Power to the... Physician?

Today I told a patient she would have to choose a different pharmacy for a requested refill. (I may tell the story of that pharmacy's botched handling of a prior authorization in a future post.) When physicians wrote prescriptions on paper, the patient chose the pharmacy, but with eprescribing and phone or fax prescribing the physician has the power (one of the few remaining for us) to choose the pharmacy.

I can choose the pharmacy that handles the order quickly, without putting me on hold for ten minutes, the pharmacist who understands me and whom I understand, the pharmacist who treats me with respect, the pharmacist who sounds competent.

By exercising choice I impose an incentive for the pharmacy and pharmacist to improve performance. By exercising my choice of pharmacy I also impose an incentive to get physicians out of this loop. Eprescribing need not require anything of the physician except approving the prescription or refill. A simple software solution could allow the patient to select where they fill the prescription, and equally simple software solutions could allow the payer (with the subscriber's permission of course) to access the electronic medical record for prior authorization information without wasting the physician's time.

Power can be nice, but this one I can do without.

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