The article “Rethinking Your Approach to Prescription ‘Refills’” [November/December 2011] provided some excellent points. I would like to suggest a few more.
Patients should be required to bring all their medications, in the original pharmacy container, to all visits so that an accurate medication list can be verified. The information found on the container is invaluable: the drug name the patient is familiar with, which pharmacy filled the prescription, who prescribed it and when, dosage form, strength, number of units dispensed, number of refills allowed, and hopefully the indication for which it is being taken. All prescriptions should be required to have the indication printed on the label because, for example, “Take one daily” tells the doctor nothing about why warfarin was prescribed; however, “Take one daily to treat blood clot in lung” gives the doctor a lot of information even if the patient doesn't know why he's taking the drug. Knowing what drug name the patient is familiar with is important because if the patient has been taking “warfarin” and the refill is for “Coumadin,” the patient could interpret them as two distinct drugs, take both of them, and end up in the emergency room with epistaxis.
It is the prescriber's responsibility to ensure that the patient will have enough medication until the next regularly scheduled appointment, plus a little more. It's reasonable to prescribe three month's worth of medication with three refills for a patient with hypertension who is scheduled to see me once a year, even though I might suggest quarterly check-ups. No physician should prescribe medication for a patient who has not been seen in the practice within the preceding 12 months. If a patient runs out of medication and has not been keeping regular maintenance appointments, this behavior needs to be addressed.
Finally, because all prescriptions are regulated, they require the physician to evaluate the patient. Even in the case of a patient self-diagnosing “sinus infection,” the physician should not prescribe antibiotics without making a diagnosis based on history and physical examination.