Sometime in the last millennium I vaguely recall learning how to write a prescription, but learning how many refills to put on a prescription has some subtle nuances that I didn’t discover until much later in life. I try to give patients enough refills on their medications to last until the next appointment, but because of medical-legal implications, I shy away from giving them refills for the entire year.
I’ve noticed over the years that some patients do not get their lab tests done despite my telling them that they must have them done before they get a refill. If these patients are taking methotrexate and not getting their lab tests done, I try to make sure they come for an office visit every few months and get their lab work at the time of their visit. But for a variety of reasons, this isn’t always feasible. If the tests don’t get done, patients sometimes misinterpret their lack of refills as a tacit permission, or unspoken instruction, from the doctor to stop the medication. In reality, all it really means is that they should have called the office for a refill. If such patients come in for 6-month follow-up visits and I notice that they haven’t been doing their labs, I gently remind them that they need to do their labs more frequently. I might schedule their next visit in 6 months, but I will only refill their methotrexate for 3 months. Three months later, when they need a refill on their prescription, I won’t give it to them if they haven’t done their lab work.
Patients also may find that they don’t feel any worse when they run out of medication, and so they decide not to refill it. It’s just human nature that they look for an exit strategy. The sad fact is that sometimes our treatments aren’t as effective as we would like to imagine. If the medication was working like a miracle, the patient would be more zealous about refilling it.
I’m often tempted to ask patients, "if you ate your last slice of bread, would you stop eating bread, or would you buy some more?" Strange as it may seem, some people like their bread a lot more than they like our medications!