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Headache Care

Headache On Prescription Renewals

Wednesday, Feb 11 2009


A final note on problem patients concerns prescription renewals. For the most part, prescriptions are renewed because the patient finds the medication useful and needs more. However, prescription renewals are a legal act and extend the physician-patient contract. Hence, you need to see your patient at reasonable intervals, depending on the drug ordered. This requires a good deal of record keeping, secretarial and clerical help, and overhead for telephone expenses, among others. It is surprising that so few physicians charge for this service. We have never done so.

Here is a partial list of reasons for prescription renewals that we have found either amusing or irritating. (1) My purse (wallet) was stolen, with my medicines. (2) I’ve lost the prescription. (3) I’ve switched pharmacies (Г—2, Г—3, Г—4). (4) I flushed the medicine down the toilet. (5) My medications all got wet in the rain. (6) My dog (cat, pig) ate the medications. (7) I’m on vacation and left my medications at home. (8) I couldn’t reach my regular doctor during the week, so I’m calling you on the weekend (or at 2:00 A.M.). (9) My medications were in my pants, and I laundered them by mistake. (10) My grandmother has used all my medicines, and I didn’t even know it. (11) My suppositories have melted. (12) The triplicate prescription has expired. (13) I didn’t have your prescription filled when you wrote it, but now I need it.

Are there other guidelines to follow when dealing with difficult patients of these types? Four rules apply.

First, do not dump difficult patients on your colleagues under the guise of consultation. It is perfectly acceptable to ask for a second opinion, especially regarding management; but this should be done with the expectation that the patient will be returning to you. If you do transfer the patient to a colleague, it is appropriate to call and advise about your problems with the patient. At least then your colleague is forewarned.

Second, do not argue with difficult patients, especially about billing, insurance coverage, and disability status. When possible, pass them along to an ombudsman who is, preferably, not a physician. Many times an ombudsman skilled in interpersonal relationships can resolve issues with courtesy and dispatch and smooth over ruffled feelings, even if only temporarily.

Third, do not become involved physically. This also applies to any sort of sexual liaison. Patients assume physicians are trustworthy, and one simply cannot violate that trust. There is no excuse for placing hands on a patient in other than a professional manner for other than professional reasons.

Fourth, do not become disillusioned. Most patients are not in the above categories. Medicine remains a calling, a service profession, and a worthwhile life pursuit. With attention to courtesy and tactful use of some of the suggestions outlined above, even difficult headache patients can be managed successfully.

Edmeads, J. (1988). Emergency management of headache. Headache 28:675-679.
Groves, I.E. (1978). Taking care of the hateful patient. N. Eng. J. Med. 298:883-887.
Headache Classification Committee of the International Headache Society. (1988). Classification and diagnostic criteria for headache disorders, cranial neuralgia, and facial pain. Cephalalgia 8:1-96.
Silberstein, S.D. (1992). Evaluation and emergency treatment of headache. Headache 32:396-407.
Silberstein, S.D. and M.M. Silberstein. (1990). New concepts in the pathogenesis of headache. Part II. Pain Manage. 3:334-342.

Editors: Silberstein, Stephen D.; Lipton, Richard B.; Dalessio, Donald J.

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