Some time ago, a patient arrived to my office prepared to enjoy the joy of colonoscopy. Many of the patients on my endoscopy schedule are scheduled by other physicians and gastroenterologists. In other words, I meet many of them for the first time on their special day. My task is simply to perform the procedure and to then refer them back to their medical professionals. In general, the system works well as we have many checks to assure that there are no safety barriers to performing the requested procedure in an out-patient setting. Even when I schedule a procedure on one of my own patients, my patient’s medical record will be reviewed in advance by another medical professional. While the system works well on the safety front, it is less effective on the medical necessity front. When an endoscopy schedule is open to referring medical professionals, there will be instances when the medical necessity of the procedure is questionable. This is a murky issue as profession
With some regularity, patients contact me requesting antibiotics. Many patients regard this as a casual and routine request, but I don’t. When I hit the ‘Send’ button authorizing an antibiotic – or any medication refill – I am declaring that I personally agree that the medicine is medically necessary. In general, I sign off on most routine medication refill requests without issue, unless the patient hasn’t seen me in the past year or so. I would hesitate to refill if patient communicates that his heartburn is worse and requests that I double the dose of his reflux medicine. This patient will be asked to see me in the office. There are times that I will prescribe antibiotics without an office visit. This assumes that there is an existing professional relationship between me and the patient and that the medical facts support sending in a prescription. There also needs to be a reservoir of trust such that the patient would contact me if his symptoms are not responding. I wo