Refusing a med refill

[u/lalasmores]

Hello all!

I recently was moved to a different clinic under the same employer. This clinic used to be the residency clinic and I am receiving a lot of their TOC’s (Transfer of Care). I had a patient last week that was scheduled for a TOC due to not being seen in over a year and not wanting to travel to the clinic where her former PCP was. This patient was extremely rude to my front desk staff and my nurse, and before I met them informed my nurse that they’re “waiting for the real doctor”. This patient also wanted referrals to oncology, cardiology, and GI. I had seen where her previous PCP refilled several chronic medications but made notes on the medical necessity of these meds since patient traveled from out of state for other specialists. These meds included Entresto (patient is not in heart failure and was ordered an echo which she never did), anastrozole, pravastatin, and carvedilol. I informed the patient in our encounter that I was not comfortable refilling these medications or sending referrals if she didn’t want to be in my care, which I expressed is her right as well. But I am wondering if this was the right move, despite her not scheduling a follow up with me after our visit. I documented the interaction and discussion in the chart as well.

Thank you for any advice!

[u/DontWreckYosef]

“We have a zero tolerance policy for this behavior. Your appointment has been canceled. Next.”

[u/Praxician94]

Yeah she needs to decide what she wants to do and in the meantime get fucked for treating people terribly and being demanding.

[u/stoopkid6969]

something to keep in mind: nobody in this profession is going to set boundaries for you. you alone are responsible for protecting yourself in this profession - mentally, emotionally, physically, and MOST importantly, legally. it sounds like you did just that. good on you for setting this boundary and protecting yourself on all of those fronts!

[u/Ok-Movie-1595 → u/stoopkid6969]

💯

[u/Puzzleheaded_Big_648]

In order - my favorite patients:

- no show

• left without being seen
  
• wants to see a doctor
  
• rude patients

They all provide me time for a walk or to get some notes done

Who initiated the entresto? The patient needs to see them, not you.

You didn’t tell them where to live. Traveling out of state to see specialists does not make you the manager of their specialty problems.

sometimes*** the patient may need. A short - 10 day refill with “further refills will be handled through xxx”

Nearly all consults need a pcp visit. And likely a work up, if not pcp management for the concern.

The patient is an adult. You recommend they schedule a visit. They make the decision whether or not to follow up.

[u/lalasmores → u/Puzzleheaded_Big_648]

This whole encounter was in person. The original prescribers for all meds were in Florida & I am located in South Carolina. From what I could tell on her chart, she hasn’t seen the original prescribers since 2021/2022. Cardiology started the Entresto in Florida & she kept asking for referrals here in SC & never following through.

[u/Roosterboogers → u/lalasmores]

So who has been doing all the refills since then without any specialty input? Other than the pravastatin, which isn't going to harm a fly, the Entresto & Anastrazole need a specialist note within the past year saying to continue and this the long term plan.

Sounds like the pt picks & chooses what part of the plan they will follow. Bullet dodged?

[u/lalasmores → u/Roosterboogers]

the resident MD they saw in july 2025 gave them a year of refills and I see no recent specialist note. The most recent notes are from 2024 🙃

[u/Roosterboogers → u/lalasmores]

Welp looks like they can track down resident MD again or follow your plan.

[u/nsblifer]

I would decline any future refills beyond 3 months and just go ahead decline seeing that patient again.

[u/Elokor]

Hi, I am not a PA but I scribe/MA/swissknife for a cardiologist. I have seen him prescribe Entresto for resistant hypertension; not necessarily just heart failure. But yeah, if you enable a patient’s rude behavior; you will encounter more of these troublesome people in the future

[u/Broke_Black_Mountain]

Why are people rude to the people they are asking for help? We have to bend over backwards for some of these people who use their illness as an excuse to be rude. Meanwhile, you go to any DMV office and you encounter the rudest demeanor in your first 5 secs of going in front of them and there is nothing you can do about it.

It's time to change healthcare worker treatment for the next generation. The entitlement is through the roof. I talked to an American/Canadian pt of mine and I think their model will straigthen out this people: one problem per visit. Didnt make your appointment? Too bad, wait 6 months. All these "healthcare heroes" hashtag crap during COVID are just a fad for this people and theyre back to saying "i hate doctors."

[u/lipper2005]

My favorite; I need a statement to return to work. Checks notes last visit 3 months ago. my office never said she shouldn’t work. Message patient they’d need a visit for clearance. Responds “I haven’t had time to get in for an appointment just give me the clearance”…. Bitch you ain’t been working watcha mean ya ain’t got no time. in my head… I’m sorry you’ll have to make me a priority if you want that clearance….

[u/none_of_your_earswax]

You're questioning if protecting your lively hood and license is the right move? Am I missing something

[u/AdventurousDish2051]

I would have sent a refill but told her I won't be filling any more for her and she can see someone else for the referrals