Who ya gonna call?

Got a problem? No budget to solve it? Need someone who will jump when you snap your fingers? For free?

Find a doctor. And hold hostage the care and welfare of the patient.

This is exactly the tactic a pharmacy at Group Health Cooperative (@grouphealth) tried to use on me when (they claim) a controlled substance I prescribed got lost "in mail." I received this note by fax five days after I ordered the refill by telephone:

"Prescription wrote on 9/7/11 was mailed to patient which has been lost in mail. Confirmed with USPS. Please write a new Rx and fax to Bellevue Pharmacy where patient will come in to pick up. -- Thanks"

(I hasten to point out that, from what I have been told, the prescription -- not the patient -- was lost in the mail. I guess pharmacists can get by these days with limited writing skills.)

Maybe HMO pharmacists are accustomed to ordering employee physicians around. It may have been a shock to them when I reminded them that I had already ordered the drug, that I only wanted the patient to have that one refill, and that so far they had failed to comply with my order, causing the patient, their subscriber, distress. It may have been a shock when I refused, but instead reported the incident to DEA and the state pharmacy board. I plan to give them a few more days to see whether they comply with my order before filing a formal complaint with the Department of Health.

My telephone contacts with the pharmacy board and DEA disappointed too. A representative of the pharmacy board failed to provide a definitive answer to the question of how the pharmacy should have handled the loss, and DEA has yet to provide clear guidance as to whether I might be in violation should I write another prescription.

Sadly, third parties of many kinds exploit physicians and their wish to protect their patients every day, and in numerous ways. I hope this example will discourage the cynical practice of exploiting physicians' instinct to protect patients, but I believe that only when physicians stop enabling by giving in will this shameful practice stop. If you the physician ultimately choose to cave in to protect your patient, at least look for ways to punish those who exploit you. For example, in the case I describe above I can refuse to order through that pharmacy, possibly forcing the patient to find a different payer or a different physician or to forgo reimbursement. I can also specify that the drug must be dispensed directly to the patient.

Doctors: Push back!