Things I Won't Do; and Some That I Will
While reading Dr. Rob's post on what makes patients angry, I was struck by how similar our practice styles are. As a solo doc, ie, no partners to whom I can compare, I found this reassuring. Yes, I'm fairly confident that I'm practicing good medicine; still, validation is nice, however it comes.
So here is a brief list -- not exclusive by any means -- of things I won't do, even at the risk of angering a patient:
- I won't call in antibiotics without a visit, with two exceptions: endocarditis prophylaxis, and the family member with documented strep scenario.
- I won't prescribe narcotics without a visit.
- I won't call in a prescription under someone else's name (if someone doesn't have insurance but a family member does.)
- I won't treat "yeast infections" over the phone. Surprise: BV doesn't respond to antifungals. (Exception: if someone is already on antibiotics, though I usually ask and prescribe Diflucan concurrently.)
- I won't treat UTIs over the phone (except MAYBE on weekends, and even then I don't like it.) The only time I really need the urine culture is when I didn't get it.
- I will write one controlled substance prescription for a new patient. No refills until I've seen your records, but you will get the benefit of the doubt once. Only once, though.
- I will prescribe birth control pills without a pap. Contraception and cervical cancer screening have nothing to do with each other. Besides, even though gynecologists are not allowed to trust women (because every single one of them has been burned by someone who swears she's a virgin but turns up pregnant) if I've known you since you were five and you're asking for BCPs on your way to college, I believe you when you tell me you haven't had sex.
- I will write for full pills even if you're splitting them. I didn't used to, thinking of it as insurance fraud, but given the obscenities that co-pays, pharmacy benefit managers, formularies and their profits have become, who's defrauding whom?
- I will treat upper respiratory infections over the phone 'til the bovines are re-domiciled. Sore throat, stuffy nose, little cough for two days: go to bed and drink fluids for chrissakes. Don't call me unless something changes or you're not getting better after a week.
Note to Clark re: Mr. Furious, "Close, but no cigar": Good thing I don't smoke.