Curious -- what prescriptions would your family doctor call in, w/o seeing you?

[TheReader]

Or, would your doctor be willing to call this in?

 

Our 16 yr old was diagnosed on Monday with Influenza A, and so prescribed Tamiflu to hopefully shorten the duration of the illness. 

 

Today, our 12 yr old began running a fever, so I called hoping they would simply call in the Tamiflu -- known case in the house, exposure, etc, it seems obvious. No, they want to see him. Which is fine, we'll go, but it got me wondering. Normal? Not? 

 

Maybe I'm still spoiled from Brazil, when DH would often simply describe the kids' symptoms to the doctor who visited his work site  weekly, and would then prescribe us stuff that way. Or "the good ole days" when our family doctor would simply write the prescription, right then, for everyone in the family, to use "as needed" when the next person(s) got sick. 

 

So...satisfy my curiosity. What's the norm these days with doctors calling in prescriptions for family members? 

[Spryte]

Well, my doc is pretty fantastic, and she's known me for 15 yrs, plus treated all members of our family that long, or since they were born. 2 of us have compromised immune systems.

 

She is now two hours away. When one of us gets a dx like flu, if others have similar symptoms she has been known to call in Tamiflu for the rest of us.

 

I probably would not expect that from most docs though.

[TheReader]

Well, my doc is pretty fantastic, and she's known me for 15 yrs, plus treated all members of our family that long, or since they were born. 2 of us have compromised immune systems.

 

She is now two hours away. When one of us gets a dx like flu, if others have similar symptoms she has been known to call in Tamiflu for the rest of us.

 

I probably would not expect that from most docs though.

 

That's a good point. My childhood doctor lived next door to my grandparents, had treated the whole family starting with my dad's generation when they were kids/teens, and known us since we were born. That does make sense why someone with that level of knowledge would phone-prescribe vs. a doctor who rarely sees us (we have been lax about well visits, and are very rarely sick, and we're still pretty new here). 

[Guest]

My doc has known me for 29 years. He'll call in the stuff where he knows I know what I'm doing for my chronic condition but not ever antibiotics or self-diagnosed new stuff. As a courtesy, I don't expect him to call in a prescription if I haven't been in in a year. He mentioned once that one of the reasons doctors hate taking on older patients is that they call all the time and don't pay their way. He is one of the few that DOES take in new Medicare patients, but I think he has a legitimate gripe. So I try not to take advantage of the free call-in refill.

 

He probably would have called in the OP's request.

[magnificent_baby]

Depends on the provider. Some are more liberal than others. As an NP, I would want to evaluate for strep which can have overlapping symptoms (or even occur simultaneously). If not, you could be missing something that truly needs treatment. If I missed something big by just assuming the 12 year old had it too, I could be held liable.

 

Also due to the age they may not be as comfortable prescribing Tamiflu. My kids pedes (at two different health systems) will very rarely prescribe Tamiflu for kids due to the serious side effects; one of them flat out refuses. So perhaps the age difference in your kids is one major reason for not prescribing over the phone.

 

Now antibiotics for the rest of the family for symptoms when it comes to strep, yes, my pedes will do that over the phone for a family member with a confirmed case. Influenza is a bit different of a ballgame.

[zoobie]

Pinkeye drops is all they've ever called in for us.

[TheReader]

Depends on the provider. Some are more liberal than others. As an NP, I would want to evaluate for strep which can have overlapping symptoms (or even occur simultaneously). If not, you could be missing something that truly needs treatment. If I missed something big by just assuming the 12 year old had it too, I could be held liable.

 

Also due to the age they may not be as comfortable prescribing Tamiflu. My kids pedes (at two different health systems) will very rarely prescribe Tamiflu for kids due to the serious side effects; one of them flat out refuses. So perhaps the age difference in your kids is one major reason for not prescribing over the phone.

 

Now antibiotics for the rest of the family for symptoms when it comes to strep, yes, my pedes will do that over the phone for a family member with a confirmed case. Influenza is a bit different of a ballgame.

 

This is helpful to know; thank you! I wasn't aware of any side effects from the Tamiflu (the pharmacist did a really crappy job going over it with me, grr). I'll have to research that. :sigh: 

[magnificent_baby]

This is helpful to know; thank you! I wasn't aware of any side effects from the Tamiflu (the pharmacist did a really crappy job going over it with me, grr). I'll have to research that. :sigh: 

 

I believe seizures is one of the main concerns, especially if they have a history of them. It's probably rare, but one of the reasons why my pedes won't/hesitate to prescribe to kiddos.

 

Good luck, we went through influenza this year as well. DD was so bored of being in bed and watching TV by the end of it!

[Zinnia]

My pediatrician will not call in anything without a child being seen.  They *do* answer phone calls for free, though.

 

Our last pediatrician would not call in anything, and phone calls cost $50 for advice.  

 

Which I get.  I really, really do, because even pediatricians are working hard at life/work balance.  I get that.  But I also don't want to take my kid in for any small thing, it end up being nothing, and I've wasted the money on the visit.  I end up using Dr. Google (and relying on my own training, which is 20 years old) a lot.  

[Bluegoat]

Normally, none.  They can't bill for called in prescriptions, and if they did it as a rule for their patients they would spend a lot of time on it without getting paid.  When I've been to more organized doctors, if they see me for an issue, they may give me a prescription just in case I need it, but I don't need to take it in.

 

I have once or twice had my step-dad call in something for me in a pinch, but it isn't really considered good practice so he wouldn't do it unless the situation was unusual.

[TravelingChris]

Antibiotics only if he has already examined us and determined it is viral and then it changes symptoms and gets worse, not better.  He refills medications but also sees us regularly.  He prescribes over the phone some medications that we have gotten from a specialist but haven't seen that specialist to get renewed.  Ony one of us has ever been prescribed Tamiflu since we don't get the flu except that one time for dd when she forgot to get flu shot and then that doctor did see her.  I think if either I or dh would get the flu now, I think the doctor would want to see us because with me in particular but maybe also dh, he may want to prescribe other medications too like albuterol for dh or increase in steroids for me.

[SparklyUnicorn]

probably nothing

 

 

[Loowit]

The kids' doctor called in Tamniflu for my oldest and youngest a while back when they got the flu.  She had told us at their well checks to call in if they were exposed to the flu and started to show symptoms.  Both have asthma.  She would not prescribe it for middle because he is not high risk (no asthma or immune issues).

 

Our old pediatrician always insisted on seeing the kids for everything.  Our new office has many more options like a nurse appointment for a strep or urine test and phone appointments if requested for certain things.  I like these options because there isn't a co-pay for them.  Last time I got bronchitis I did a phone appointment and they called in a prescription without me having to go to the office.

[AmandaVT]

Nothing. My Dr. wanted to see me for everything. She would call in refills for prescriptions I've had in the past- like a refill on my inhaler if I have a bad cough, but that's about it. 

 

Same with the Pedi. 

 

They are both very conservative about prescribing anything, which I like in theory, but it can get annoying on occasion.

[zoobie]

Depends on the provider. Some are more liberal than others. As an NP, I would want to evaluate for strep which can have overlapping symptoms (or even occur simultaneously). If not, you could be missing something that truly needs treatment. If I missed something big by just assuming the 12 year old had it too, I could be held liable.

 

Also due to the age they may not be as comfortable prescribing Tamiflu. My kids pedes (at two different health systems) will very rarely prescribe Tamiflu for kids due to the serious side effects; one of them flat out refuses. So perhaps the age difference in your kids is one major reason for not prescribing over the phone.

 

Now antibiotics for the rest of the family for symptoms when it comes to strep, yes, my pedes will do that over the phone for a family member with a confirmed case. Influenza is a bit different of a ballgame.

 

Our ped will only prescribe Tamiflu for children who are immuno-compromised or have some other serious risk factors for the flu. They say the see more complications from Tamiflu side effects (dehydration due to diarrhea I believe) than benefits to using the med. They've told us Sambucol is as or more effective in kids. 

 

They won't do antibiotics without a positive test strep test either. I haven't called with extenuating circumstances though. That might make a difference.

[Guest]

Pretty much anything but controlled substances or antibiotics unless there is a standing order or recent diagnostic appointment concerning either. If we have been in recently and need a refill they'll call it in. Like when we need more phenobarbital for Benny, they just call in refills even though it is a controlled substance, because it is an ongoing diagnosis we are addressing and the script hasn't changed.

Edited March 29, 2017 by Arctic Mama

[TheReader]

My pediatrician will not call in anything without a child being seen.  They *do* answer phone calls for free, though.

 

Our last pediatrician would not call in anything, and phone calls cost $50 for advice.  

 

Which I get.  I really, really do, because even pediatricians are working hard at life/work balance.  I get that.  But I also don't want to take my kid in for any small thing, it end up being nothing, and I've wasted the money on the visit.  I end up using Dr. Google (and relying on my own training, which is 20 years old) a lot.  

 

Wow....they charge you $50 to call & consult during office hours? Or after hours? 

 

You can't even call with a question, and the doctor call you back, without paying for it?? 

 

Yikes. 

[Carrie12345]

It's hit or miss for us.  The rest of the family got Tamiflu after the first two kids were seen a few years back, so that was nice.  We've had a doc order extra eye drops for pink eye.  One urgent care doctor (my favorite) saw one of my kids and called an inhaler prescription in under his name for his brother.

 

I was not, however, able to get my regular doctor to call in abx for my own UTI, which was really annoying!

[Zinnia]

Wow....they charge you $50 to call & consult during office hours? Or after hours? 

 

You can't even call with a question, and the doctor call you back, without paying for it?? 

 

Yikes. 

 

The practice charges $50 for phone advice at any time.  The exception to this is when a medical assistant can answer your question during office hours.  And while I really did like their medical assistants, almost all of the time (well, I can't think of any exceptions), my questions were not able to be answered by the MAs, and I needed physician input.  Which is why I was calling them.  Because I had exhausted google.  :)

[Crimson Wife]

Pinkeye ointment

Yeast infection pills when OTC creams aren't enough

 

The urgent care center affiliated with the local hospital offers e-visits for $25. I upload a photo and description of the symptoms. They'll either diagnose based on that or apply the fee towards the co-pay for an in-person visit.

[TechWife]

My doctors will only call in refills of an already prescribed medication (and only then if they've seen me in the last six months). The only exception is when I have been in the office and we discussed two possible routes of treatment - if A doesn't work, we can move on to B. If A doesn't work, I can call and let the nurse know and they will call in B. If A doesn't work and we didn't talk about B, I will have to go back in. I totally understand why - doctors really shouldn't be diagnosing and treating without observing the patient. To me, it's common sense and it is also a liability issue for them. 

Edited March 29, 2017 by TechWife

[redsquirrel]

Honestly, I assumed it was against regs, but maybe it's to do with billing. Once I was able to convince them to give us a script, but that was for pinworms. I told them I had seen one in  a diaper and we needed treatment for the whole family as a precaution. It took some finagling from the nurse, but she was able to get the script called in.  I offered to bring in the dirty diaper for inspection, if that would be helpful, lol.  That seemed do the trick.

 

But for anything else, no, I can't imagine they would call in a script without seeing the patient.

 

Oh, I have had the family GP give us a script but tell us to hold onto it because we didn't need it at that moment, but if things progressed then it was better to just get the meds than make another appointment. For example, I can imagine if I took one kid in for the flu, he would absolutely give us scripts for everyone else 'just in case'.

[Liz CA]

Anything I've had before but since I am with a naturopath, some items are not necessarily a rx. Her office staff can also approve renewals of rx when she is not available.

I think she may do something in an emergency since I've known her for some time.

[fairfarmhand]

Our family doc sees everyone in the family.

 

Tamiflu, after the'd documented one case, they'd call that in.

 

diflucan, yes, they'll call that in.

 

Topical steriod cream for my dd's eczema, they'll call that in.

 

 

[Ethel Mertz]

Our doc will do renewals for medications we're already taking. I always have to go in to get an antibiotic for a UTI, with one notable exception: I was 3 states away, keeping vigil by my mother's death bed, and I came down with a UTI. My doc called in cipro to the out-of-state pharmacy where we were. Also, I got a just-in-case cipro rx when I was traveling out of the country.

[xixstar]

Mine would have most likely called flu meds in for a second child. He has called in meds for croup before. And he would probably call in antibiotics if he felt it was warranted but we've never had that come up.

 

We have a many year relationship and I assume he's figured that I am fairly "with it" and very thorough in providing information when I call. And I never call him at home unless it's a very big deal. But for the flu on a second child, I can totally see him calling it in even during normal office hours.

 

Anyone, if we could come in, he would prefer that. But usually call-ins have been needed over a weekend or over Christmas holiday when we are calling him at home and have an acute need.

[Joker]

Ours will call in quite a bit. The last time one of us had the flu, they wrote prescriptions for Tamiflu for all of us just in case. We had two of those filled and one of us never needed it. Of course, our doctor has given us his cell number at times and kept in contact over the weekend of one of us was really ill so he might not be the norm.

[LMV]

Or, would your doctor be willing to call this in?

 

Our 16 yr old was diagnosed on Monday with Influenza A, and so prescribed Tamiflu to hopefully shorten the duration of the illness. 

 

Today, our 12 yr old began running a fever, so I called hoping they would simply call in the Tamiflu -- known case in the house, exposure, etc, it seems obvious. No, they want to see him. Which is fine, we'll go, but it got me wondering. Normal? Not? 

 

Maybe I'm still spoiled from Brazil, when DH would often simply describe the kids' symptoms to the doctor who visited his work site  weekly, and would then prescribe us stuff that way. Or "the good ole days" when our family doctor would simply write the prescription, right then, for everyone in the family, to use "as needed" when the next person(s) got sick. 

 

So...satisfy my curiosity. What's the norm these days with doctors calling in prescriptions for family members? 

 

We don't see family medicine doctors currently. DH and I have PCPs in a local IM group and our children are established with an amazing pediatrics practice so I'm answering this in that context and perhaps that makes a difference. I suspect that our kids' pediatrician would want to see them before prescribing but I've never asked her to call in anything (which isn't legal in our state anyway) and I really can't imagine a situation where that would be what I wanted. I generally think that if a prescribed medicine is needed then an in person evaluation is also needed. Our pediatric practice has never not accommodated a request for a same day appointment when I or DH have asked for that for one of our kids. 

 

As a side note, Tamiflu is most strongly recommended for kids under five or kids with chronic conditions which make them higher risk for influenza mortality and post influenza complications. I probably would opt for Tamiflu for our twelve year old but that would be because of her underlying lung disease. I suppose this is another reason to schedule an office visit for a risk benefit discussion in the context of the individual child's medical history. 

Edited March 30, 2017 by LMV

[TheReader]

So, I took him in. He does have the flu. I saw our preferred doc, who's actually a NP, who we love so much (way better than the other 2 at the practice, who are both actual doctors, but one is a very old man, and not thorough, and the other is a brand new doctor who doesn't yet have confidence in herself). 

 

She was so great; I'm glad we went in. We go back tomorrow for her to check up on the oldest (recovering from pneumonia, and currently flu free....) because he's got some new symptoms and we weren't thrilled with the "follow up" with the other doctor. 

 

I'll adjust my expectations of US doctors, though, thanks :) I was just spoiled, I guess, by my family doctor growing up and then our doctor in Brazil (or maybe healthcare in Brazil in general...). All the reasons you guys have given as to why they might not be comfortable issuing a new prescription over the phone make a lot of sense, so thanks for chiming in. 

[fdrinca]

When we were in PA, our ped would write scripts for abx after tick bites if the tick had been on for some period of time (I don't recall, it changed as new information came out). 

 

I feel like our ped in CA would call in scripts for issues we've had in the past - ointment for impetigo, for example - or if a second or third child started to show signs of illness that one child was being treated for. Then again, I've never tried. I'm sure the type of medication and the complications from misdiagnosis would be considerations.

[Laura Corin]

We have some prescriptions on repeat.  I think that I have had an antibiotic for UTI called in before.  I think that's it.  

[Alice]

At our practice we we generally call in:

-eyedrops for conjunctivitis for kids over the age of 3 (younger kids are more likely to also have an ear infection and might do better with something oral) 

-prophylactic antibiotics for dog/cat/human bites 

-pinworm meds

 

Any of those the nurses who take calls during the day would get the info and call it in or if we were on at night we would likely call it in. We will also usually call in meds someone has been on before for a recurring non-infectious issue (asthma meds, eczema/skin meds, etc). We will only do that if they have an up-to-date physical. I will sometimes call in meds for swimmer's ear in the summer...it has to be an older kid where we are fairly sure it's not an inner ear infection. 

 

I will sometimes call in meds for a family member. I would possibly have called in the Tamiflu for the OP. I would prefer to have the patient seen in the office to check him out. But if it was the weekend or late in the day and hard for the family to get in we might do it. We'd likely explain that we prefer to see them and ask them to come in. 

 

Our policy is not to call in antibiotics for strep, ear infections, UTIs, or other things. I have on occasion done it and I have almost always regretted it. The reasons we don't do it are that we want to be judicious with antibiotic use and we want to make sure we have a clear diagnosis. A UTI in kids is something we worry about more in adults (depending on the age of the kid) and we want to know we have a definite diagnosis before just treating it. If a kid has had a UTI sometimes it means further testing and I don't want to do that based on presumptive diagnosis over the phone.  I will occasionally call in yeast meds for a teenage girl...usually they aren't sure what it is and I usually want to make sure that they it isn't actually an STD. If they have had yeast infections in the past then Imight do it. 

 

I'm more likely to call in meds for patients I know well. 

 

People here probably won't believe it but cost has never been a factor for me or the other docs in my practice for what we call in and what we ask people to make an appointment. I'm not thinking "oh, if you come in we get paid". It has more to do with making sure that the patient is treated properly. 

Edited March 30, 2017 by Alice

[Alice]

I'm not sure how to edit on my phone. I realized after I posted that pinworm meds are OTC now but we used to call them in when they weren't.

 

Another one we call in that I forgot is lice shampoo.

[Zinnia]

 

People here probably won't believe it but cost has never been a factor for me or the other docs in my practice for what we call in and what we ask people to make an appointment. I'm not thinking "oh, if you come in we get paid". It has more to do with making sure that the patient is treated properly.

I believe this. I was a hospital based CNM before I had kids, and for me and most of my colleagues, the money/how we got paid/billing was completely divorced from patient care in our minds.

 

In the local practice that charges $50 for advice from the physician, I get the idea that she is equal parts business person and provider. Which is a bit unique. BUT. She has 4 kids, works part time (2.5 days of clinic time plus administration duties), and is able to have a really great work/life balance, while still owning a very successful practice. So what she is doing is working. And I applaud that. Because for a whole lot of providers, that success eludes them, at least in one area.

[JudoMom]

Our pediatrician would/has for the boys, but we've been with him for 17 years.

 

Dh and I see the same primary care doctor, and he would/has for us as well in certain circumstances.

[TheReader]

At our practice we we generally call in:

-eyedrops for conjunctivitis for kids over the age of 3 (younger kids are more likely to also have an ear infection and might do better with something oral) 

-prophylactic antibiotics for dog/cat/human bites 

-pinworm meds

 

Any of those the nurses who take calls during the day would get the info and call it in or if we were on at night we would likely call it in. We will also usually call in meds someone has been on before for a recurring non-infectious issue (asthma meds, eczema/skin meds, etc). We will only do that if they have an up-to-date physical. I will sometimes call in meds for swimmer's ear in the summer...it has to be an older kid where we are fairly sure it's not an inner ear infection. 

 

I will sometimes call in meds for a family member. I would possibly have called in the Tamiflu for the OP. I would prefer to have the patient seen in the office to check him out. But if it was the weekend or late in the day and hard for the family to get in we might do it. We'd likely explain that we prefer to see them and ask them to come in. 

 

Our policy is not to call in antibiotics for strep, ear infections, UTIs, or other things. I have on occasion done it and I have almost always regretted it. The reasons we don't do it are that we want to be judicious with antibiotic use and we want to make sure we have a clear diagnosis. A UTI in kids is something we worry about more in adults (depending on the age of the kid) and we want to know we have a definite diagnosis before just treating it. If a kid has had a UTI sometimes it means further testing and I don't want to do that based on presumptive diagnosis over the phone.  I will occasionally call in yeast meds for a teenage girl...usually they aren't sure what it is and I usually want to make sure that they it isn't actually an STD. If they have had yeast infections in the past then Imight do it. 

 

I'm more likely to call in meds for patients I know well. 

 

People here probably won't believe it but cost has never been a factor for me or the other docs in my practice for what we call in and what we ask people to make an appointment. I'm not thinking "oh, if you come in we get paid". It has more to do with making sure that the patient is treated properly. 

 

Your list absolutely makes sense, and I definitely believe you that cost isn't a factor in whether or not you'd call stuff in. I might think the insurance company is a bunch of crooks, but I've never felt that about any of our doctors, ever, and I'm not upset in the least that we had to go in and be seen for this; I really was just curious, because I realized the bulk of my experience comes from 2 pretty unique situations -- my family doctor growing up, who literally cared for 4 generations of our family by the time he retired; and our doctor in Brazil, where things are kind of more lax. 

[EKS]

The only thing my doctor has called in recent times (meaning in the last 20-30 years) for me is an antibiotic for a UTI (and when they said they'd do that, I was astounded).

[G5052]

At our ped practice, they will make an exception for pink eye if you've had it before, but otherwise they want to see you. It's the policy.

 

Our internist is a little looser that way, but we've been seeing him for over 15 years. If he could see that one of us had been in with flu, he'd probably call in Tamiflu. Once when DH was very ill and declining in a hospital over an hour away, I called asking for a sleeping pill. Getting there during his office hours was going to be very difficult. He did it.

[maize]

I think our family doc has called in antibiotic prescriptions for the whole family when a couple have tested positive for strep and everyone else is reported as having the same symptoms; he will only do it though if he has seen each person in his office within the past year or so (physical or other visit).