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Be Careful What You Wish For

January 15, 2013

In another entry concerning how you would rather spend your time…

Say you go to your doctor, he/she says you have high blood pressure, and he/she puts you on some sort of pill.  A prescription for something.  So you go home, you take it, it works.  Maybe you have a home BP machine or you use the one at the local CVS.  You run out of pills.  Your prescription has run out.  You need more.  You take you blood pressure; it’s fine.  You call the doctor:  “Hey doc my blood pressure is great!  Can you call in a prescription for more of those pills?”.  Chances are your doctor will say “No, you have to come in and be seen.”

Say you have been on an anti-depressant forever.  An SSRI like Prozac or something.  Anyone who takes those knows you can’t go off them cold turkey.  You move to a new state.  You get a new doctor.  You call that doctor: “Hey doc I’m new in the area and I need a prescription for my antidepressant medication.  This is what I take, I’ve taken it for years”.  Chances are that doctor will say “No, you have to come in and be seen”.

Say you run out of contact lenses.  You’ve used the same kind for years.  Your vision is fine, you’re pretty sure your prescription hasn’t changed.  You try to order new lenses on-line.  The company calls your ophthalmologist who won’t renew the prescription.  You guessed it: “No, you have to come in and be seen.”

There are valid reasons for this answer.  Doctors can check for side effects you might not have noticed, document stuff, cover their medico/legal requirements, get you in front of them so they can follow up on other problems you may or may not have.  It kind of feels a little condescending, like you the patient doesn’t really know what you need, someone with more education has to tell you or verify what you are saying.  Whatever the reason, the answer “No, you have to come in and be seen” is likely to drive you nuts.  Because now you have to find a day off, come in, wait, and pay a copay, all to find out what you already knew.  Then you have to go to the pharmacy and get the refill.  Every month.  For reasons which are unfathomable a lot of insurance companies only let you get a months worth of a prescription at a time.

As soon as you agree to take a drug and get a prescription for it, especially if it’s something you will have to take for a long time, you have tethered yourself just a little to the healthcare system.  You will have to spend just a little more time in doctor’s offices.  That’s fine if you need it.  Just be sure you really need it.

Try to stay off drugs.  If the doctor says you need something for your blood pressure, tell her you’ll lose weight and exercise for 6 months and then if it’s not better, then try a drug.  Same for cholesterol.  Anti-depressants are tricky because, while the patient knows what works, he/she has to recount an entire life’s worth of therapy to a stranger.  Blood thinners are by far the worst.  Coumadin will buy you guaranteed doctor visits every week or month forever.  Contact lenses?  Find a good pair of frames.

If you really need a prescription, keep track of the expiration dates on the prescription.  There’s nothing worse than running out and having to wait a month for an appointment to get a refill. Find out if your insurance company will let you get three months at a time, or even better, order through the mail.  If you have to go in for an appointment, make sure you know your dosage and any side-effects you might have noticed.  At the very least you might be able to shorten your visit a little.

Be as healthy as you can be.  You want to live in the world, not the doctors office.

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