No Refill

(I wrote this in 2010, but every once in a while this still happens because I don’t make it clear enough that some medications need monitoring before making them permanent.)

Skip Rollins drove 35 miles to see me today for his blood pressure follow-up. A few months ago I had prescribed a mild diuretic, hydrochlorothiazide. I had ordered a blood test to be done a while after he started taking it in order to check on his potassium level and kidney function. Then I saw him in follow-up, and his blood pressure was normal. We had agreed on a follow-up in November.

Looking at his chart before knocking on his exam room door, I saw numbers I didn’t like – 154/110. His blood pressure was right back where it started.

It didn’t take long to figure out what happened.

“Oh, those pills, I ran out of them a month ago. You didn’t give me a refill”, Skip rumbled in his big-barreled baritone voice.

I paused.

“No wonder your blood pressure is up again, then, Skip. I’m sorry I didn’t check if you had a refill, but, you know, you can just call us or have the drug store contact us if you run low on your medication.”

“Oh, I figured you didn’t want me to take any more of them.”

“No, I just didn’t want to write for more than one refill when we started with that medicine in case it wasn’t going to work out for you.”

I wasn’t sure he needed to hear that I also don’t write for several refills in case patients don’t get their labwork or no-show for their follow-ups.

“Well, I see the stuff worked, and I still seem to need it”, Skip mused.

“Definitely. Once someone’s blood pressure is up, it usually stays up unless they lose weight or cut out the salt. Your blood pressure was real stubborn at first, remember? Here’s a script with refills for a year, but I’d like to see you in March again, okay?”

As medical providers, we often assume our patients will understand our routines and our way of thinking, but, at least around here, so many of our patients have little or no experience with disease and with the health care system. Skip never imagined that high blood pressure was a chronic condition with possibly lifelong treatment. I thought everybody knew that, and I failed him.