Online Rx with no exam or pt contact?

Specialties NP

Published

Can someone please explain to me how these weight loss, antiaging and other type of online clinics are prescribing prescription medications to patients who are never physically examined by the prescribing practitioner? All they do is fill out an online medical history, pay and get a prescription or a medication delivered right to them. I saw alot of this with overseas pharmacies but now I see it going on here in the US. How can this be legal (because there's no way it's safe!)??

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The same way people get a prescription from a provider who doesn't do a ROS and listens to breath sounds through a shirt..........providers without a conscience!

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Specializes in Anesthesia, Pain, Emergency Medicine.

Listens to breath sounds through a shirt? AND?

LOL

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And ?? It is just one example of shortcuts that providers take that are inexcusable, not thorough and dangerous.

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Specializes in Anesthesia, Pain, Emergency Medicine.

listening to bs through a shirt is "inexcusable?

i find thin shirts fine to listen through.

[color=#009999]although the "gold standard" clearly is that the chest piece should be applied to the bare skin, a rough screening of both heart and lung [color=#009999]sounds can be done through a thin t-shirt. button-up or polo shirts can be a problem because of buttons, pockets and heavy weaves [color=#009999]near listening areas. however, unbuttoning a few buttons at the top shirt often allows sufficient access to the area without [color=#009999]unbuttoning and removing the entire shirt. further, decent screening of the lungs can often be done over the shirt from the back [color=#009999]without taking it off---if the shirt is fairly thin and not furry; like a plaid or suede.

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listening to bs through a shirt is "inexcusable?

i find thin shirts fine to listen through.

[color=#009999]although the "gold standard" clearly is that the chest piece should be applied to the bare skin, a rough screening of both heart and lung [color=#009999]sounds can be done through a thin t-shirt. button-up or polo shirts can be a problem because of buttons, pockets and heavy weaves [color=#009999]near listening areas. however, unbuttoning a few buttons at the top shirt often allows sufficient access to the area without [color=#009999]unbuttoning and removing the entire shirt. further, decent screening of the lungs can often be done over the shirt from the back [color=#009999]without taking it off---if the shirt is fairly thin and not furry; like a plaid or suede.

i've never seen any reason to do it. and i don't. i mean, really..isn't it so much easier to just lift up their shirt rather than to stand and debate the cloth or textile make of their shirt ??? maybe "inexcusable" is a bit harsh. lazy, yes, not thorough, yes...but probably not inexcusable. there's just no real need to do it. i suppose in the rare trauma case maybe? i've never had to do it. i'm sure it may seem a small issue to some, but to me it's part of not compromising or taking shortcuts.

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Specializes in Anesthesia, Pain, Emergency Medicine.

What you find difficult (listening through a thin shirt) others with more experience may be able to perform quite well.

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Specializes in Nephrology, Cardiology, ER, ICU.

I work in dialysis - I'd better not be lifting up my pts shirts - its too public.

However, that said, I have an electronic steth that works very well, even listening thru a shirt when the pt has a permcath and is dialyzing.

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What you find difficult (listening through a thin shirt) others with more experience may be able to perform quite well.

I don't find it difficult at all. I just refuse to take shortcuts. The good, thorough providers that I know (practicing for 20+ years) STILL don't do it. It has nothing to do with skill. I *could* totally do it. I just never will.

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Specializes in Anesthesia, Pain, Emergency Medicine.

Once again, when you get more experience, you might change, or not. Don't run down other providers who may be good, thorough provider that are able to listen to breath sounds under a shirt.

I consider the lungs to an area of expertise. I've done anesthesia for 20 years now and never had a misplaced ETT or even a right main stem that I did not pick up, OMG sometimes through the gown. :)

I don't find it difficult at all. I just refuse to take shortcuts. The good, thorough providers that I know (practicing for 20+ years) STILL don't do it. It has nothing to do with skill. I *could* totally do it. I just never will.
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Once again, when you get more experience, you might change, or not. Don't run down other providers who may be good, thorough provider that are able to listen to breath sounds under a shirt.

I consider the lungs to an area of expertise. I've done anesthesia for 20 years now and never had a misplaced ETT or even a right main stem that I did not pick up, OMG sometimes through the gown. :)

I think it's lazy. That won't change. All of the older, more experienced providers I know think it is lazy too. I've been assessing breath sounds now for about 15 years and haven't missed a CHF or pneumonia but I HAVE watched providers (both NPs, PAs, MDs, etc) go in, give a quick listen through a shirt or gown and announce clear breath sounds when an Xray shows otherwise. In my current practice setting,the whole gown thing isn't really an issue...most are in street clothes and it is never a problem to lift up a shirt.

I'm kind of done with this conversation. You aren't going to persuade me that I'm inexperienced and that is why I refuse to do it. I'm not going to persuade you that it's a lazy assessment skill. So let's call it a truce? :confused::cool:

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Specializes in Nephrology, Cardiology, ER, ICU.

Sometimes we do just have to agree to disagree.

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