How hard is it to write a prescription?

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A woman calls Sidney Medical Associates for a new prescription each month. It is a maintenance prescription for her and she asks for it to be dispensed for the non-generic form. She had tried the generic after her doctor (whom she really likes) inadvertently had her try the generic formulation and she found the results significantly differed from the regular, name brand drug.


The woman thought she had worked out the issue, but each month that she calls in for the prescription (a Nebraska rule), the person who takes the call appears to misplace the message and the woman usually ends up having to call multiple times over multiple days. Attempts to take care of the issue over lunch result in tales of unavailability due to the doctor being out to lunch (no pun intended).

The woman then has to take time off from work in the mid-afternoon or leave work early in order to get what should not have taken so much effort to achieve. She is upset, her employer is potentially upset at the lost productivity and the doctor's office could care less.

Now I am putting words in the doctor's office's mouth, but you see the issue is a repetitive one. Nearly every month for more than a year the woman goes through the same routine. Nearly every month she receives a prescription after sometimes multiple phone calls, and/or trips. Nearly every month, she receives her prescription that includes the option of using generic formulation, instead of requiring the brand name that is proven to work in her case.


In 2001 the cost of a doctor's office visit was $45.00. Today it is $92.00. Sidney Medical Associates has made tremendous strides in the use of technology that has made it easier for them to store patient records (electronic since 2003). I have had two office visits in the last 3 or so years for a chest cold. Two different doctors saw me, yet the second one was able to pull up my prescription history from the other doctor. That is a good thing.

I have to ask a few questions here:

1. Why is it then that the doctor's office has such a problem communicating with patients such as the woman above? 
2. What happens to the messages taken by one of their employees that seem to find the longest an slowest route to their destination? 
3. And finally, when a patient discusses with her doctor the effects of a generic drug vs. a branded one and the determination is made to honor the request to use the branded one in the patient's interest, why can't the patient charting system that is part of the reason office visits are so high, make an effective note for the patient's benefit.

People complain about the high cost of health care and rightly so. Tort reform might be part of the solution, but improving patient care at the most basic level might have a bigger impact. Hiring people who can properly forward a message about a prescription is one component. Having other people in the chain, including doctor's who remember the details of their patients enough to know that the generic form of a drug doesn't provide the same response as a branded version would be nice. And yes, having such prescriptions ready when the patients arrive would mitigate lost productivity from having to leave work early.

I think most of us agree that the doctor's and nurses and staff do care about their patient's well-being. By and large, patient care is probably acceptable (worked for me). As difficult as the overall health care situation is, actually caring about the little details can save a large amount of money, and just maybe lower the cost of incompetence in the delivery of health care.