Who should prescribe meds- specialist or primary care physician?

[kingstonight]

Who should be the one to write prescriptions. The specialist, or the primary care physician?


Thx

[houghchrst]

Both can write prescriptions based on what you need but make sure that they both know what you are taking so there is no conflict.

My rheumatologist writes my scrips for my arthritis meds and my primary writes my scrips for my asthma and general meds that I don't need to see a specialist for or that I only saw a specialist once and got a recommendation for a particular med.


have a good day

[kingstonight]

Yes, I understand that both can write a script, yet if someone has several specialists, it seems as though the primary care physician can be easily be left out of the loop. Especially if the patient doesn't mention it. One of the weakest links in managing care can be from patient miscommunication.

Is there a conventional recommended practice? What do the Dr's prefer?


Thx

[Gymnast_Navy_Wife]

Like like the other poster, my pcp and all my specialists prescribe my meds. Each specialist is generally "in charge" of the meds prescribed for the condition(s) they treat. However they can and do prescribe some medications that may be relavent to another speciality. Just depends on the circumstance, reason and time. This includes my pcp as well.


In my hospital system, all medical records are computerized, which include a list of medictions the patient; so, (at least in theory) all my doctors know and have access to the info. Usually, the list gets looked over & updated-- (either by the patient or the health care profressional) at each visit (to any dr). Of course, due to the nature of computers and complexity and just plain weirdness of the system things have a tendancy to get mixed up, not completely entered or deleted, etc etc (and in my case its even worse because my meds change so much). In any case, it is essentially that each doctor knows what meds your on.

A lot of it, in my experience, which dr prescribes what meds (ones that don;t pertain to their speciality) is also about comfort level and how long the patient has been on the med.
Right now, my pcp likes to be kept in the loop with all my medical conditions (not as in detail as the specialists, but an over all idea of them and treatment) and I see him every 3-4 months -- whether I am sick or not. So, for the most part and with the meds I've been taking a while--such as my seizure meds or vitamin supplements, he is comfortable with prescribing most of them if I need it. It can , and sometimes does, saves me a phone call to or visit to my specialist, time and energy.
On the flip side, there are things my pcp won't prescribe AND things normally prescribed by my pcp or another doctor, another doctor won't touch at all.

So, it can go either way and just varies a lot from terms of conditions, type of med, dosage and the doctor....

:) GNW

[houghchrst]

Another thing is that it is common practice for specialists to send reports to the primary letting them know what was done for their patient. That way the primary is not left out of the loop. Now I have had occasions where there was shoddy office work being done/not done and things have been misfiled so the doc said well no I don't see that or we didn't get that only to find it later in someone else's chart. But it is a common courtesy that if the primary sends a patient out to a specialist that the specialist sends back a report to the pcp letting him/her know what was done for the patient.

The last pcp I had would have the nurse go down my list of meds first thing every visit. This new one I have to let him know. Yes if I remember. Thank goodness I don't see him so often.

[brainandspinalcord]

I know from personal experience that when you start getting several people writing prescriptions there can very well be counter indications that slip under the rug. Whether it's thinking the other docs have checked already or just oversight I don't know, but I always double check with the pharmacist to make sure the combinations are safe and effective.

[houghchrst]

As soon as I get a scrip I go home and get on the puter and run them through the Check my Meds site and then go in depth to research the med. I don't check the med through the med's website either. You only get some info there. I use a lot of different sites. My pharmacist is great because he will automatically tell me if there are any med conflicts. He won't tell me if some of the side effects may add to my depression or irritate my bipolar disease or little things like that. That is why I go online.

I have a neuro that I visit and every time I go I tell him I am not taking the Reglan and why, I give him an updated med list that he reads and copies, then before I leave he writes me refills for my scrips, including the Reglan. I mean Duh!!! How dense can you be? I just told the man I was not taking it and why and he writes a scrip anyway. We do this little dance every time I see him. So now I just take the scrip and shred it into tiny pieces before I trash it.

[jeffreyfrog]

I believe the only 2, other than the physician themselves, are nurse practitioners and physicians assistants. They do, however, work directly under a physician, and aren't able to write certain prescriptions like high-level narcotics.

[Ladybug]

In our case, we have multiple specialists and the pcp refuses to even write a script for fear of doing something wrong with all the complications of the case. In fact, he won't even order a basic blood test. He wants the specialists to handle everything and just keep him in the loop. The pcp will provide basic care treatment like antibiotics, but that is it. I do know many pcp's that will order special prescriptions for people, but not when they have specialists. With various family members, we have found that the pcp wants the specialist to instruct them on what to do or not do. This helps to not confuse treatments, but makes it completely frustrating for getting basic care that really should be handled by the pcp.

[ceejay2005]

No they cannot prescribe any medications nevermind narcotics. Only medical doctors and dentists are able to write prescriptions.

[Naominjw]

I go to an allergist only once every 4 years or so. He may write a prescription, but then my GP/PCP takes it from there. An endocrinologist or sleep specialist may get a person started on a bunch of meds, but if they are working, the GP/PCP takes over writing the prescriptions. The only things the GP/PCP does not write are the ones he really cannot because of doctor rules where-in ONLY a specialist can write them.

Our GP/PCP is like the conductor of an orchestra -- worth his weight in gold for highly complex cases with lots of other doctors involved (not my case, but my daughter's). He teleconferences when needed, faxes results when needed, gets together packets of info with a cover letter when I take my daughter to yet another specialist - like http://itsnotmental.blogspot.com/2008/06/new-doctor-visit-medical-history.html only so much more.

The problem is finding a GP/PCP like that. We take all the info to him - he is the central repository. He is even taking over for the psychiatrist for a couple family members, especially since it was under HIS care -- adjusting things medically -- that they finally got better, with the psychiatrist looking on saying, "Duhhh, but I don't understand!" All right, I'm exaggerating. He didn't actually say "Duhhh."

[houghchrst]

My nurse practitioner writes scrips for me about every other month so it can't just be medical doctors and dentists.

[mrsdoubtfyre]

Nurse practioners (provided they have that license) can write any RX including controls.

In Michigan optometrists can write RXs only for eye diseases.

[Daisy]

Frankly I've had better luck with my pharmacist coordinating my meds and my specialist than my PCP who often doesn't recognize some of the meds I'm taking. Before you say switch I have several times and it isn't just one but many who lack knowledge of epilepsy and the drugs we take. I generally contact my nuero and use the pharmacist as back up for interactions.

[comfortzone]

I'm a trainwreck on this track too. First I get a new set of knees at the end of the year. Got new hips 3 years ago and did great. But the knee pain never went away and I'm 9 and 5 mos. out. Suddenly joint pain everywhere - from toes and limbs to hands wrists and fingers, ankles shoulders ....... never had that before. So the Orthopedic surgeon is patient and gives pain meds till week b4 last when I was proud to tell him that I'm just getting used to the pain....I should be okay without anymore. Well then my microwave broke and I hauled the 35# thing to the garage and brought the new one in --- the next 5 days were the worst imaginable pain days ever. Both arms and legs -- especially elbows. I cried because it seemed to reactivate these days I used to call WALL OF PAIN days....where I new when I opened my eyes every pore hurt on me. So I went to a silly urgent care to get a sling and brace (not helpful) and a few more Norco. I see the rheumie who decides I have Benign Hypermobility Syndrome and gives me tramadol and tells me to rub Voltaren over my body. Whatever. Neither helped and there went $ I didn't have to waste. So she doesn't want the Norco. The primary care doc I see on Monday will have reports and such from everyone - but may or may not help me with the pills that used to help my pain go from a 7 down to a 2 or 3. It works fairly well for me. Next I see Pain Mgmt and Phys. Med and Rehab cuz my orthopedic surgeon doesn't know what to do with me. Meanwhile suddenly no one wants to or has time to fill out my VITAL LTD paperwork. The ortho guy wanted help but never called when he said he would. I may ask to have it and give it to my PCP even though she's kinda out of the loop.....Or do I give it to the Pain Mgmnt guys who I've never met? Bottom line Rheumie wants 8 More weeks of PT I've already done 8 months people! and owe them thousands. So for sure I can't work for at least 8 more weeks and with the pain I had today I feel like never will I work (a nurse on my feet 12 hours). SSDI clearly understood and began paying 3 months after application -- but it's the LTD that will allow me to pay rent etc. I even tried to fake through a job interview but when I had a hard time getting out of the chair I was honest about my recent surgeries (not the Bhms) and gee guess what they never called me back!)......I'm so terrified. I'm gravely depressed now and see a shrink once a week just to cope .... chronic insomnia for over 2 years now. Lots of the other usual non-pain HMS symptoms as well. I know this may seem minor to so many of you that suffer so grievously --- but I had to vent. I hurt, I'm confused, I'm broke, I think work is discriminating against me trying for a desk nursing job perhaps - they never will interview me even with the doc's okay if I should want to try.....If I had the world my way and I have to live with these tender wacky joints I would want to just take Norco as I have zero to 3 times a day depending on the day, go to a personal trainer rather than another ignorant PT that tries to overbend my already messed up joints, demand nicely that my LTD paperwork be done or there will be legal consequences (in a nice way I like my OS), and have work try to fit me in a job that might work for me -- where I could still work in my water pool work for my joints......

Thanks for listening...I walk like a toddler, drop things like a 98 y.o., forget things like someone with a bad mental illness, don't want to get out of bed.........and have gained 20 pounds in 2 months due to being angry and depressed. That might as well be suicide with 4 fake joints.

[houghchrst]

Welcome comfortzone and believe me you are not alone. There are many of us here that struggle with daily pain, ignorant doctors, a myriad of meds that don't work and forking out the money to find that nobody can really do anything. There are a lot of forums here that you could make yourself comfortable in. I spent most of my time in Emotional Support but there is Chronic Pain, Depression and many others. Hope you look around and stay with us.

Here are some gentle hugs to help you get through another day (((((HUGS))))