To Refill, or Not to Refill?

I have an ethical dilemma, and would appreciate the opinion of the Collective. Patient with controlled hypertension who hasn’t been in for a visit for over 2 years keeps requesting refills on her medications, despite multiple requests and decreasing quantities first of refills, then of medication quantities. We are finally down to my Note to Self in the Refill field, “No more refills without visit.” Pharmacy request comes in for refill. No call from patient; no appointment on the schedule. Ideally, I like to see my hypertensive patients twice a year, but I’ll settle for annually. This patient hasn’t been in for over three years. What to do? First round of analysis: What are the harms of going off BP meds? Answer: potentially significant, in that patient is on several meds which are controlling BP well, and has other cardiovascular risk factors.  Next, anticipating the patient’s objections to a visit: Why exactly to I need to see her? We call it “monitoring”; making sure her BP is still controlled, and that there are no side effects or other related (or unrelated) problems emerging. “But you never do anything,” I hear her responding, and it’s hard to argue. It certainly seems that the greater benefit comes from continuing to authorize the refills. What’s the down side? This: What if something changes, and either the BP is no longer controlled, or something else happens as a result of the meds (kidney fai...
Source: Musings of a Dinosaur - Category: Primary Care Authors: Tags: Medical Source Type: blogs