People are busy or sometimes a little lax in doing things they need to do.  As you get older you tend to regress into child like behavior and generally put things off to the last minute.  You do this as if you have no sense of how things should be done.  Children who are organized are a rare find and people probably view them as eccentric. That's another interesting subject.  Medications when they are necessary, need to be filled and refilled as though they are.  Just as it is important that you don't forget to take your medicine you should also know that you have to allow time in order for it to be refilled. This means that once a patient is down to the last few tablets or when he or she can see the bottom of the bottle this means that you will have no more medication left if you continue to take them.  To assist themselves with medication refills pharmacies often send over a patient's prescriptions to a physician's office so that they can have it refilled in time before the patient is out of medication.  This is great because the patient will not remind you until the last minute and usually when they are down to the last pill or have not taken their medication for two days and then they suddenly demand to have it refilled. A patient usually looks at the receptionist like a lowly paid servant and expects he or she to whip up a batch of pills in an instant no matter who or what kind of doctor is supposed to prescribe them. Hmmm. Internal medicine doctors can prescribe almost anything, so doctors who specialize just walk around with blank prescription pads and have decently paid, happy receptionists because they are not driven bzonk for calls regarding medications for ailments concerning any part of the body. There are times that I often want to suggest to the patient to pretend that you are having a drink and that in drinking you can see the bottom of the glass,bottle or cup(for the folks who go no frills). When you see you are at the bottom before you are finished you order another one or rerefresh your drink.  You certainly don't stand or sit there staring at something empty knowing you want more---this applies to anything! Why? Because it will take longer to get, leaving you without especially when you don't want to wait. This concept must be applied to getting medication refills. Once you see the bottom appear you must get through to the pharmacy to get more, or contact the prescribing physician or someone who should be prescribing them for you and inform them in advance that your medication bottle is showing it's bottom and that you need more.  This will give the office and or pharmacist enough time to gather your assorted triage of formulary supplements so that they can be dispensed to you and you can continue your dosage without interruption due to the prescription verification and pharmaceutical intake process.  Another problem is that patients must be seen by their physician every three months or so for routine tests to ensure that a medication and dosage is continuously effective, otherwise why bother taking them.  Rules are the rules. You need an appointment to get your refills. People change or go through illnesses ect. that may require an adjustment in medication. If you continuously take the same medication without regards to your overall condition and new onsets of problems that particular medication or dosage may no longer work or prove to be ineffective along with your other medications.  This is why such tests are necessary or seen as necessary to continuously monitor them.  Ok, so you run out of the doctors office without making an appointment because you talked so long with the doctor about everything else that was going on in your life without discussing your health problems which took some time messing up everybody elses appointment or the receptionist was too busy to pencil you in for one, or you had an appointment but you had to reschedule because of other obligations, or you were angry at the receptionist for being  to the point with you because you asked her a question that pertained to billing and she suggested that you contact them about it, so you became a no show at your scheduled appointment.  The fact still remains that you need an appointment along with your prescription.

IDEA:

We must use the pharmaceutical infrastructure to alert patients when they need appointments. Patients will skip town regarding a doctors appointment but they will sure as hell show up for that pharmacy fix.  Once things become EMR'ed and more user friendly this will become of great value. On an EMR system a pharmacy should be able to inform the doctors office that a patient will need a refill. Any good EMR system should have this category as a way of e-mail to communicate with the doctors.  In that EMR  pharmacy refill request for patient medications should also include the question- Does the patient need an appointment, yes or no?  and will you only prescribe 7, 14, 21 or 30 days worth of medications until their next appointment?  Once the doctor's office reply's or responds to the question, this will alert the pharmacy so that when the patient calls to ask if their medication has been refilled or is it ready, the pharmacist can inform them that they do not have any medication for them because they need an appointment or that they will only be getting enough of a supply until they see their physician.  One may ask why can't the patient just call the doctor instead for all of this information?  Good question? A patient will call and the office will give a thirty day supply.  The patient will then try to avoid seeing the doctor all together and just go through the pharmacy who in turn will fax ect. over information requesting medications for a patient to be refilled or they will sometimes call for this request. So that we are on the same page in that the patient needs an appointment and will get no more medication unless he or she keeps it, things need to be done a certain way.  Once things go electronic overall and such communication becomes the norm; when a refill request is made the information communicated as listed above regarding: the patient needing an appointment or will only be given enough medication until they visit the doctor will be provided to the pharmacy.  The pharmacy can then give that information to the patient as they are standing there like they are at a bus stop or something or they can send it to their smartphone or tablet mail address because they no longer use a landline anyway or are never home to answer any messages or letters sent regarding necessary appointments. Patients will make things seem as though the receptionist was plotting against them and therefore refusing them their necessary meds in order to assume some absurd control over them. I like EMR. I like communication. I like infrastructure. I like pharmacy with EMR communication infrastructure.