Quote from emtneel
Do any of you have similar experiences.<br>
Or other reasons that you won't/don't prescribed certain medications?
I have LOTS of personal rules when it comes to prescribing.
Absolutely will not Rx:
any narc stronger than norco (and rarely even that)
benzo's of any kind
ritalin or other ADHD meds
This has a lot to do with my very, very underserved and frequently mentally ill and substance-abusing patient population. I hate pain management with the fire of a 1,000 suns, and in my neighborhood once you get a reputation for being willing to Rx for pain meds - it becomes 100% of your practice. I absolutely will not go down this road. When new patients present to the clinic already on multiple narc's - I apologize, explain this is really not the best practice for them, and refer out to other clinics.
I have had patients show up requesting narc refills whose original prescriptions came from county ER's. Any ER doc who is too weak-spined to discharge a patient with no physical evidence to support chronic pain with NEW scripts for narc's can clean up their own mess. I have sent more than one of these patients back to the same ER with a referral that says as much. Harsh but I have to safeguard my own sanity first.
I think Gabapentin is generally a crappy drug and I rarely initiate it. Will continue someone else's Rx if I inherit a patient. Frequently bring patients off of it, because if you ask them about pain management - you learn it doesn't help them at all. But they continue to take 4g/day until someone tells them it's okay to stop!
If you don't keep all follow-up and lab appointments, I WILL stop prescribing your anti-seizure meds. The majority of "seizure" patients have no documentation to back up their history and most anti-epileptics have significant street value.
I will almost never Rx PO hormone replacement for menopause. Will do premarin cream if I absolutely have to. Also won't routinely test hormone levels in most women and basically never in men. The only patient I have on testosterone at the moment has Klinefelter's.
Yes, I spend a lot of my clinic time being a major hard-a$$ about prescription drugs
Conversely, because of how underserved our patients are, I AM more willing to prescribe other meds that some practitioners are wary of. I will manage DMARDs, anti-depressants and mood stabilizers, and chantix for smoking cessation (although I currently have a 0% success rate w/ chantix and it's my last choice for medical support). I have a few patients on dopaminergic meds for parkinson's and parkinson's-like symptoms. I will medically manage cardiovascular, renal, and liver trainwrecks to the best of my ability in an outpatient setting.
Very interesting question, OP. Would love to see more responses.