Health Matters
by R.D. O'Bryan
Nov 15, 2012 | 863 views | 0 0 comments | 5 5 recommendations | email to a friend | print
Among the more common questions we in the health care industry encounter involve whether it is truly necessary to visit in person to “get a prescription refill,” “get an antibiotic” or just “ask my doctor a few questions.”

These are certainly good questions. In a chronically sluggish economy, as cost-conscious folks try to keep their expenses down to pay for their other necessities, the inconvenience of spending time and money on a doctor’s visit can be a tough pill to swallow.

However, as with most things in our world, there isn’t an easy answer.

In general, the answer to all three questions above is yes, it is necessary — although a qualifying “but it depends on the medical issue” is certain to be included.

First and foremost, your health care provider is a practitioner of the art and science of diagnosing, treating and preventing diseases, disorders and injuries to the human body. Science is always based on observation and the organized pursuit of discovered evidence to correctly diagnose and treat a problem.

Your health care provider went through years of academic and hands-on training and continues to learn and evolve to stay medically current and to keep active licenses. Thus, your health care provider has an ethical duty to practice medicine correctly. Of course, this is primarily for the benefit of providing high-quality care. However, medical practitioners must also be able to defend their actions against possible litigation.

This call to duty and sense of protection can come only with thorough, detailed documentation of the patient’s history, medical complaint, medication and allergies, followed by the practitioner’s observations, exams, diagnosis and treatment. Obviously, all of that cannot happen over the phone.

In the case of refills, most health care providers do refill medications for chronic conditions — such as high blood pressure, high cholesterol and diabetes — that their patients need and use consistently without necessarily being seen in the office every month.

Doing so is still legally viewed as a continuance of care, however, and prescribers are equally responsible to ensure that refilling a medication via fax is safe for the patient and meets the standards of medical care.

As a result, most practitioners will take the time to pull the patient’s chart, latest visit records and recent lab work and review the fax request to be sure that the refill meets the medical, ethical and legal obligations discussed above.

“Getting an antibiotic” or “getting some pain pills” or “getting something for stress” or seeking another medication to fix a sudden problem are all problematic requests. Most seriously, these questions put practitioners in a very uncomfortable situation by asking them to “buy off” on a diagnosis and treatment plan made by a well-intentioned but untrained person.

Even discussing the case on the phone doesn’t allow the health care provider to see the patient, examine the patient and comprehensively evaluate the entirety of what the patient may truly need.

Most physicians’ phone lines are not recorded, so there is no evidence of what anyone said. Phone consultations can become time consuming, too, which usually takes time away from other patients who are waiting in a room for the doctor to get off the phone.

So while a person could potentially save a little money and time by avoiding an office visit and a co-pay, receiving pharmaceutical therapy without a face-to-face encounter with a medical professional could completely backfire and not just fail to help the patient, but even make things worse. Likewise, your doctor is left in a potentially high-risk position that could lead to a lawsuit, insurance company audits and medical board inquiries.

Certainly, this doesn’t cover every scenario. Talk to your own health care provider about guidelines for telephone advice, refilling medications by fax and when it is necessary to have a face-to-face encounter between the two of you.

Richard O’Bryan, a volunteer columnist for the Irrigator, is a nationally board-certified and licensed physician assistant and former Patterson paramedic who practices at the Patterson First Care clinic. Information in this column is not intended to replace advice from your own health care professional. For any medical concern, consult your own doctor. Readers can email questions and suggestions to

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