Repeat Prescription

 I have a pharmacist friend who runs a medicine shop. He often dispenses psychotropic medications. As he is very meticulous, he makes sure that the prescription is a valid one, records the required details, checks the patient's identity and then gives the medication. This means he has to turn away patients who come without a prescription or come with an outdated prescription. Patients tell him they do perfectly well on medication and so what is the harm in just giving it to them? And why should they pay the Psychiatrist an exorbitant amount to just have the same particulars copied down with a new date on it? I, too, face a situation where patients send me a text message with a picture of their old prescription and ask me to reply with a picture of a prescription with a 'new' date. I can fully understand that a patient who remains well on the same medication for several years feels that the process of follow up with a Psychiatrist is totally unnecessary. But for the patient's own safety, the matter has to be a bit different than what 'common' sense would suggest.

Psychotropic medications have to be taken on a long- term basis. During this time patient can have other disorders, start other medications, undergo surgery, have changes in weight, attain menopause or menarche (in female patients), develop new sources of stress, have old stress reduced down and so many other factors that will need a change in the dose of medication. Patient undergoes ageing process which changes the medication response. Some psychotropic drugs have to be monitored for side effects. A good number of mental illnesses will progress despite medication and the early signs of progress need to be picked up to prevent a full relapse. For all these reasons, regular follow up is absolutely essential. When the patient is feeling quite ok, there can be early signs of problem or risk factors for a problem- which can only be picked up during examination by a Psychaitrist. During routine follow up these are picked up and larger problems prevented. Psychiatrists also use the opportunity of follow up to educate the patient about proper diet, exercise, stress management and other important subjects relevant to maintaining good general and mental health. 

Legally, no medical advice can be given without adequate examination of the patient. Prescription is a written advice of the doctor. So, no prescription can be issued without proper examination of the patient. Even if the patient, their whole family or anyone gives full assurance that patient is doing well, and the current medication suits him/ her- such reassurance has no value. The only thing that can be the basis of writing a prescription is a thorough medical examination by the doctor writing the prescription.

And it is only reasonable that the doctor (Psychiatrist) who has worked to examine the patient, apply expertise to solve not only the present problems but to foresee and prevent the imminent ones and explained everything to you in detail and then written all that down in the form of a prescription- should be paid the consultation fee!

PS- If you feel the doctor is not giving enough time- change the doctor. Dont do the shortcut of avoiding consultation and continuing medications.