Patients who call the clinic 1 day before meds run out for refills

[JZ_RN]

We usually do up to 3 months or even longer of refills. We see over thousands of patients per year in our practice. However, what is with the patients, who are told to call us 2 weeks before they are out of refills and medication to request more, yet call us the day they need the pills and are going to be out?

Is there a way to prevent this?

I am running a clinic and I can't drop everything 20 times a day to hunt down the MD and get them to do a refill for every person who calls screaming about being out of pills or just shows up at the office.

Advice or input appreciated!

[nursel56]

It sounds super frustrating there. Part of the reason I enjoyed my clinic jobs was that for the most part the doctors and the staff were on the same page as far as the procedure for doing refills, walk-ins, the laundry list of problems they expect taken care of in 15 minutes, and when it's OK to interrupt you for a phone call from an irate patient when you are with someone else (answer:never)

Of course there are exceptions, but for the garden variety stuff, like if you were a no-show for your last 3 appointments and then you show up wanting a refill, you will not get it, and you will make an appointment. It's disrespectful to the staff and the patients who follow the rules to have things running in such a chaotic fashion.

If you can get your docs/staff/management to support you, you could institute some rules that will eventually make everyone's life less stressful. I'm starting to feel bad about talking up ambulatory care now, lol.

[JZ_RN]

I enjoy it much more than my old job, But these are the problems that we run in to now haha. We do have rules, the problem is that our patient population doesn't follow them. They don't say, oh, okay, and go home and call for a refill on time. They throw a ghetto-style (for lack of a better word, sorry, I'm not trying to be offensive or judgmental. but it is what it is lol) fit and we have to call security. I don't know what else to do.

[SHGR, MSN, RN, CNS]

.

Do people honestly not realize they aren't the only and most important person in the world?

No, they do not! If the possibility ever crossed their mind, they ignored it.

[nursel56]

We had an "on call" doc each day on a rotating basis, when they had very few, if any scheduled appointments, so we would invite the tantrum-thrower to have a seat in the waiting room and we would try to work them in. Invariably, if the wait was greater than 30 minutes people would begin to complain about the lousy service they received when they barged in unannounced for a non-urgent problem. People are so funny . . .in a narcissistic sort of way.

[RN58186]

The pharmacists in our clinic deal with refill requests. When pts run out and don't have a follow up booked, or haven't had bloodwork done recently, we will bridge their supply until we can get them into clinic and they go to the lab. And if they don't show for that clinic appt the "leash" gets shorter and shorter - i.e. we might give a one month bridge, then a two week one, then one week, and we keep shortening the time frame until they get the hint. We have some pts who have gotten themselves down to one day supply of meds, and we will not lengthen that time until they come into clinic and have appropriate bloodwork drawn. And after a week or two of having to trek to the pharmacy everyday, they decide the lesser of the evils is to come to clinic and get their bloodwork done. We absolutely do not get the doctors to see a pt just because they dropped in, unless we have assessed the pt and determine that it really must be dealt with immediately. Pts "pitching a fit" at the nurses or pharmacists (or clerical staff) for any reason will not be tolerated by our doctors and when the pts do eventually come to clinic they will get a firm talking to from the physicians. Since there are only two programs in this part of the country that deal with transplant pts, our doctors tell them if they don't like how we do things they are welcome to transfer their care to the other program 3 hours up the highway. The nice thing is we get total support from our doctors and managers and it is an established practice of dealing with these pts that we all follow so the pts always get the same message, regardless of who they speak to.

[HippyDippyLPN]

we get this all the time at my clinic, I love the pt's that call at 4:30 pm on a Friday after the docs have left needing a RF on their BP med that they ran out of yesterday. Thankfully we have EMR so we just task the md's and text them to grant it if they are out of the office on these occasions. Our policy is if its a b/p or DM med we havta rf it so they dont run out. We do however though only give a 30 day w/o rf and we tell them if they do not make in an apt int he next 30 days they are SOL and we will not RF again but this is for people who havent been in for their check ups. For reg run of the mill meds we just task it and the md will grant it when he does his tasks. The major issue we have is getting pts to come in for labs a few days before an appt, they do not have to pay a co pay and literally you are here for 10 minutes at most, you wouldnt believe the fits people throw! The md's prefer to have the BW in hand to discuss any med changes that may need to be done instead of trying to explain it over the phone after the fact. I try to explain time and time again its for better patient care, its for YOU the patient so that you are informed. But no we are just a blood sucking md's office who wants their money lol.

[SHGR, MSN, RN, CNS]

Friday...lady who was last in the clinic in March, noshowed in August, yelling at me on the phone about her T#4 script. I relayed doc's message that appt needed in order to refill. She wouldn't stop yelling! "She cannot tell me where I have pain and where I do not have pain!" Wow. I almost hung up on her when she would not speak to me in a civilized manner...she finally calmed down when I pointed out the noshow...Really, you think we should just keep refilling narcotics without an exam or a visit? We are educated, responsible professionals, not the candy store.

[Sally Now]

I agree, adhering to the policy is ideal. However, issues with patients running out of critical meds (BP, heart, benzos, anything that could be life-threatening) is an issue. It's a legal issue as well.

[JZ_RN]

A lot of our patients get their meds through a manufacturer program, so they pay a very small fee for a lot of expensive meds (which they still whine about, sometimes saving literally THOUSANDS of dollars, but that tiny fee of less than 20 bucks is just ridiculous, what are we thinking!?) so they call us right before or after they run out (had 3 month supply or more) and want us to do new forms, new income verification, new prescription, they never want to come in (or pay for an appointment) and when we tell them it will take a couple weeks before they send the new medicines (manufacturer's programs sometimes take up to 2 months) they say, well what am I supposed to do until then? (I sometimes wanna yell, be responsible and plan ahead but hey) So we offer them a prescription at the pharmacy at full price but oh no, that's too expensive and I can't afford it. Can I have samples? Well we don't have samples of that med. Can we change the medicine for now then change it back? Well, no, sometimes there is no alternative or allergies or it's the cheapest already or they need to be on a specific med. Well, what do you expect me to do then? Well, you can either buy the med for full-price at the pharmacy or go without, and you should call way ahead of time next time and let us know. No one manages my life and rushes around because I didn't bother to act on something until it was an emergency. I am just tired of patients who think I have nothing better to do than jump for their trivial needs that they didn't worry about at all until today. And no, I can't afford to pay for your meds because "I have a good job." /vent