Clinical Cross-Coverage Collegiality Conundrums

(A 3 day prescription for a chronic pain patient?)

Last night I posted a piece from 2019 titled Today’s Doctors: Colleagues or Free Agents? about the lack of elbow rubbing and camaraderie among primary care doctors. And in 2018 I wrote The Art of Covering about how much we should, or have the right to, change a patient’s treatment plan when we are covering for another doctor.

One of the things I find frustrating about having someone cover for me is when they won’t simply refill a medication that the patient is stable on. This is almost always only when controlled substances are involved. But I have seen a cholesterol medication only refilled for one month instead of three, even though the only risk involved by simply hitting the refill button is that the patient might save some copay money.

When it comes to controlled substances, I have worked with providers who will only refill a medication until I am back in the office, even if that is only in three days, or for one week instead of 28 or 30 days. This causes the same copay problem but it also complicates my refill when I am back in the office and want to resume the original prescription interval. I will then have to do the math again… 3.5 pills daily times 28 days, let me see… This can lead to prescribing errors. It is an unnecessary waste of time to have to do this. And looking up the state controlled substance database for the usual amount also takes time, which there isn’t much of in today’s Fee For Service environment. And those reports only need to be checked every three months in Maine.

What’s the danger in refilling a long term prescription the patient is stable on? A prescription that, in my judgment, has greater benefit than risk. And, if the people I work with think I am totally incompetent and lacking judgment treating my own patients, how come they dare to go on vacation and have me cover for them?