Today one of my patients had a simple request – “Doc, I don’t know if you need to write new prescriptions, but my pharmacy will ask for a refill if I do.”
I said that I it is my policy to always write refills in session so that I can make sure that I and my patients understand what medications they are supposed to be taking, and so that I can see if medications are getting filled at an appropriate frequency.
An hour later I got a refill request from Walgreens for a different patient. It was for his lithium. But, it was for a dose of lithium that I discontinued 5 months ago. Lithium is a medication with a very narrow “therapeutic window.” The difference between a dose that is effective and a dose that can harm or even kill you is quite small. It is not a trivial matter when a pharmacy asks for a refill on a lithium dose that was discontinued.
So, I called the pharmacy and spoke with the pharmacist. I asked him why this refill had been requested. He glanced quickly at the computer screen (pharmacists are very busy) and said this was a simple request. He was out of the medication and he did not have any refills…
It was only when I asked him to look a bit more carefully than he usually does that he noticed that this medication was discontinued by me months ago.
I also have had several conversations with this patient, an accomplished professional in his field, about the need to turn off automatic refills. And he has assured me that he has asked them to do that several times.
The pharmacist was baffled about why the Walgreens computers had requested a refill, since the patient never did. He suggested I call Walgreens to complain.
So I did. I was on hold for 20 minutes. And then I spoke to Cindy at 1-800-Walgreens.
I mentioned to her that this is the second time this week that Walgreens has asked me to OK a refill on a medication that I discontinued.
I strongly recommend that my patients DON’T USE WALGREENS. Alto is a pharmacy that will deliver medications to your home. They have focused on making communication between the doctor and the patient easy, and they aren’t a big corporation where responsibility for mistakes is never clear.