Hi All …
Some EMR’s are flexible enough to allow the following.
Zocor costs the same for 10 mg as 20, 40 or 80 mg. This is true for many meds. If the doctor writes for 10 mg a day, the patient is charged the same as 80 mg a day. So, if the doctor wants him to be on 10 mg a day, why shouldn’t the doctor help his patient by writing it as 20 mg a day and have the patient take a half tablet each night? Or maybe better yet, 40 mg and take a half tablet every other night?
The economic savings are HUGE, up to 50%. Hopefully, your EMR is flexible enough to let you write the prescription in the alternative way but still have a table showing how it is actually taken. Of course, you would keep a record of how it was actually written. I do not believe this illegal nor unethical. In fact, it might be unethical not to, unless the risk of patient confusion is too great. But hopefully, your EMR issues a medications list with dosing instructions. Simply cut with scissors and you have a alternative stick on label.
Cheers … Gil
Gil Carter, MD, JD
60 second peek movies of TSMR in regular use: http://www.TenSecondMedicalRecord.com, in regular use since 1990; pre-TSMR2008 versions remain free; uses Microsoft Word; can be used as an adjunct to other EMR programs.
Note: the text of the above post will not cut and paste with the “quote function.”
selected past EMRupdate discussions:
i. EMR Problem Lists: common failures: http://www.emrupdate.com/forums/t/13605.aspx?View=Flat
ii. The multi-problem visit & its best format: http://www.emrupdate.com/forums/t/13017.aspx?View=Flat
iii. Medication Transition History: How many screen transitions to see dose change history? http://www.emrupdate.com/forums/t/11993.aspx?PageIndex=1
iv. Multiple Hospital use EMR: http://www.emrupdate.com/forums/t/11752.aspx?
v. EMR Problems w/ deleting, correcting & fixing mistakes: http://www.emrupdate.com/forums/p/12377/77742.aspx#77747
vi. Best grammatically correct & coherent EMR: http://www.emrupdate.com/forums/p/12209/77538.aspx#77538
vii. Problems with excessive granularity: http://www.emrupdate.com/forums/t/11995.aspx?
viii. Language converting EMR’s, text speaking EMR’s: http://www.emrupdate.com/forums/p/11997/77282.aspx
ix. Reducing the amount of typing: Re: For Doctors who can type even a little bit: http://www.emrupdate.com/forums/p/13016/79631.aspx 01'08
x. EMR Spell Check functions and their look and feel: http://www.emrupdate.com/forums/t/12513.aspx?View=Flat ?
xi. Work Notes, making them fastest: http://www.emrupdate.com/forums/t/12514.aspx?View=Flat
xii. electronic prescribing and monitoring of physician http://www.emrupdate.com/forums/p/11723/75658.aspx#75660
Zocor costs about $5 per month at Sam's Club regardless of dose. I guess you have to decide if it is worth the hassle and potential liability for your patient to save $2.50.
I say let them suck it up and pay the $2.50. One or two less lottery tickets won't hurt them.
In the long run, the question will be how do we handle all this kind of prescription hanky panky when we will be forced to do electronic prescribing.
Most of my patients want me to not mention the little fact that they are cutting pills so the insurance company won't be the wiser. Regardless of what you believe, it is not ethical for me to lie about the patients prescription. I won't do it.
Why risk my license so the patient save $2. That is truly nuts.
What are the ethical issues here?
Is there a statement from your professional group about this?
If I were to Rx Lipitor 20 mg S: take as directed M: 90, what's the problem if the patient is directed to cut them in half? Or take them on alternate days?
Graham http://www.synapsedirect.com/ Synapse - the EMR for smart users
The real savings is taking simvastatin 40mg 1/4 tab po od *with* grapefruit juice ! probably equals 40mg !
:)
Gil,
Is this what you are looking for? Or do you want the prescription to show something other than what the patient is supposed to take?
Margalit Gur-Arie
Purkinje
www.purkinje.com
Elidan- if you state on your prescription "take 0.5 tablets a day", your patient will get half the number of pills for the same copay, which defeats the purpose. It's always better to write for the usual dose, but then give a written reminder to the patient to split the dose of medication. Sure, there are stupid patients that will forget or disregard what you've stated, but in those cases, give them the right dose on the prescription the next time. If there is an important medication that could result in toxic doses if taken at a higher dose (s.a. Coumadin, Dilantin, and Proscar), I would think twice about having a patient cut them.
I agree that it really doesn't make sense with simvastatin (ie generic Zocor), but iwth other meds, s.a. Viagra or Cialis, cutting the tablets can lead to significant savings. Check out the proprietary pill cutter for Viagra:
Gil- anything new on the TSMR front?
Al Borges, M.D.
● Oncologist in a Small Group Practice in Virginia
● My website URL: http://msofficeemrproject.com/
Hi All,
Thanks DallasDoc for pointing out the price of Zocor. I wasn’t aware that it was one of the meds whose price had dropped so far. It wasn’t a good example for me to pick. :) Of course, if you want to frequent a different pharmacy, savings there would be larger.
Hi gchiu, one of the problems is making it so your record that you look at when seeing your patients reflects half dose while your prescription for the pharmacy shows full dose. If you write for half tablet, the patient would not get the same savings.
As rx written: 40 mg q hs
As told to take: 40 mg half tablet q hs
Savings per year = 6 fold
Your record should reflect both versions.
I agree, I do not see an ethical issue.
DrMurdoch, touché, … just don’t ruin your teeth with too much grapefruit juice. :)
Elidan, Yes that’s the way the rx would be meant to be taken, but not the way it would be written. With your EMR, if you write the rx as 40 mg qd, how does it look in your medicine list table? Hopefully in your meds list, it will read as 20 mg qd (or 40 mg 0.5 tab q hs), rather than 40 mg q hs so that you remember or know his actual dose when working with him. Probably most EMR’s consolidate a meds list from its prescriptions. This is probably not very feasible with most EMR’s … but you could use a special symbol in the Rx to alert you to half dosing.
Hi Al, … Yep the new TSMR2008 should be out in a couple of months. I need to make a dated list of what’s been added. I’ll put it in a post soon. The biggest addition is a function that interweaves the multiple SOAPs in a multi-problem visit to give an alternate appearance. 60 second movie clip: http://www.tensecondmedicalrecord.com/interwoven2/interwoven2.htm Remember that F11 toggles back & forth from full screen. There’s also an alternate format for those who use their employer’s EMR & cannot use tables and other word processing functions in their progress notes.
Interwoven SOAPS ?
I think it's clearer to keep them apart, why mash 'em all up ?
No doubt - and a great idea.... but will a jury agree with the logic when the patient gets an 'iatrogenic' complication?
Disclaimer: I am the founder of e-MDs. Highest rated by doctors. All posts are opinion only
Hi Jason, … I prefer individual soap’s too. The logic is so linear. But I’ve met those who like the interwoven better. In some settings, the billing codes are set by professional billers. For them, it may be easier to count elements and organ systems easier when it’s interwoven. And for some physicians, separate soap’s seem too unusual. Oh well.
Hi Dave, … your point is well taken. It would be best only to do it with those patients you know to be competent. It is clearly better not to use such a system with those patients in nursing homes, hospice and situations where there are caregivers or a chance for misunderstanding. Even further, it might require avoiding refills to avoid misunderstanding. It would be so easy for a patient to pick up a refill and take it the way it says on the pharmacy’s label, … even if it saves the patient $3,000 a year. But … it’s so hard to throw away that much money!
It’s not a no-brainer.