Compliance – the Dilemma

Recently I posted on the topic “Are You Compliant?” after reading an article in a medical publication. It dealt with the problems physicians have because patients are not compliant with taking their medications as directed.

Compliance is more complicated and not just an issue specific to patients. Compliance requires participation from all parties.

Here are the relevant concerns:

1. Physician. When I arrive at my appointments the nurse reviews my information and specifically, my prescriptions. The doctor has made two changes to my prescriptions with regards to dosage in the past 18 months, but while those changes were given to me during the appointment, they were not modified in the records or with the pharmacist.

2. Pharmacy. When I arrive at the pharmacy I find the previous (higher) dosage is still on the label.  I told the pharmacist it was not correct and he advised he could not change it unless the doctor provided the change.  I understand their protocol.  I have advised the doctor and nurse, but no corrections have been made.

3. Physician (part 2).  During my last appointment I advised the nurse the dosage was incorrect. She was going to make the correction on the chart. When the doctor arrived and reviewed my chart he read the dosage, but it was still incorrect. I told him he changed that number of pills several appointments prior. I asked if he was going to correct the dosage in my chart and with the pharmacy. His response – ‘I can if you want me to. It just means you’ll have some extras in case you ever need them’.  (Extras?)

4. Insurance Provider. I received a brochure from my insurance provider explaining how important it is to take my medications as directed. They have my medical and prescription records. As they monitor those prescriptions it would appear to them I am not taking the medications as directed based on purchase records – I’ve been purchasing on a six-week basis instead of every four weeks. This is due to the physician not correcting the records concerning dosage.

5. Pharmacy (part 2). I asked the pharmacist about the dilemma. She checked the records and it still shows a higher dosage. As for accurate records, she said it depends on the doctor. She continued that certainly if the dosage went up they would need to have it on record, but if it went down, it just depends on the doctor.

So my dilemma is:

(A) my doctor apparently thinks it’s ok to have extras around in case I need them (am I supposed to determine that?)

(B) the pharmacist can only change the prescription if the doctor notifies them

(C) my insurance provider has the impression I am not taking the medication as directed.

(D) I do not want an issue with my insurance provider.

(E) If someone looked at my prescription it would not present the correct dosage, which could be critical in an emergency situation or with a new physician.

To date, it remains unresolved.  I only hope the next time a medical periodical writes a story on compliance they might mention the part about how important it is for the physician to provide accurate records – the same information given direct to the patient.

Your thoughts?






2 thoughts on “Compliance – the Dilemma

  1. Same problem, only an error. MD faxed in (or sent in electronically) a refill for a rx I’ve been taking since 2002. Between the MD, the clerk, and the pharmacy, the dosage was halved! When I went in to get a new rx, I was told I could not have it – it was too soon and the ins company would not pay for it. The phcy would not issue the new rx, even though my MD’s office sent in the emergency rx within 15 minutes of my panicked call to his office. At that point, I just asked for 18 pills – 9 days worth – and paid for them myself. This is medication for hypertension, so it was very important. The same for my RA meds – mixups about MTX and Plaquenil. Differing dosages in MD records and phcy records. I get the calls about not ordering meds on the “proper” schedule. Finally I went up the “chain of command,” and told them to stop calling me. I’d take the meds on the schedule I had to in order to avoid serious side effects. I hate all this. Coordination of care is becoming a dictatorial nightmare.

    • I agree it is a ‘coordination nightmare’. I read these articles on medical publications concerning patient compliance – and then this experience. I would have thought the MD would want the proper dosage in the charts. I would think the pharmacy and insurance provider would require the correct dosage (or at least expect it). The next time I get a notice from my insurance I will contact them and go on record about what I’ve been told. This was the fault of the doctor’s office. I just don’t understand why, when they are typing on a computer, they cannot enter the correct dosage in the charts.

      Perhaps we should require discharge notes after each visit which details the directions given by the MD. Accountability?

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