Boundaries

I’ve had a longstanding policy in my office that routine prescription refills will only be addressed during regular office hours. No evenings; no weekends; if you need a refill of your long-term chronic medications, you need to call during regularly scheduled office hours, five days a week. You can leave a message if you like, but you should not expect us to call in the medication until the office is open.

The main reason for this policy has always been medical: prescription medication requires appropriate monitoring. From the moment I hung out my shingle, I’ve made it my habit always to write enough refills on your medication to last until the next time I need to see you. In all likelihood if you need a refill, what you really need is a visit.

The logical reason for the policy is the need to consult the medical record before authorizing refills. And when those records are contained on bits of dead trees on shelves in the office, there’s no way I can access them if I’m not physically there. I’ve been known to drive out to the office at decidedly odd hours for the express purpose of consulting those records so that I can provide appropriate care to my patients. That has always been the bottom line for me, and always will.

Now I have an electronic medical record that I can access from any computer. For the moment, of course, it contains only a vanishingly small proportion of the data in my paper records, because I’m transferring it into the EMR patient by patient, as I see them or take calls and messages. This includes prescription refills. I must confess that with E-prescribing, I am like a kid with a new toy. Clickety-click and it’s done. What fun!

In the course of this change in the way I keep my records, I have been putting in some very long hours indeed. The more patients I have entered into the system, the easier things will get. In the meantime, though, it’s been quite the grind. And still, people are calling at all hours for their refills.

Last night I made the conscious decision not to deal with a routine refill request for a chronic medication refill from home, even though I had the technological ability to do so. Don’t get me wrong: the previous weekend, I gleefully logged onto my system to enter a note about a telephone conversation and ePrescribe an antibiotic for a urinary tract infection. This was different. No one was going to die if they didn’t get their Flonase until morning.

Just because I can refill prescriptions anytime, anyplace, doesn’t mean I have to. I choose to establish the temporal boundary afforded by my long-standing policy limiting routine prescription refills to regular office hours. I remain available to my patients after hours, and my new EMR allows me to do that much more effectively, once I can access everyone’s records. But I need to balance that with down time; off time; times when I will not log on and attend to routine — as opposed to emergency — matters.

I’m having a lot of fun with my new EMR, but I feel the need to keep it in its place: the office.