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Why is my PM doctor doing this?

This is long I am sorry.... A little background information. I am 26 years old, female. I have been seeing this PM doc since approximately 2 months after my surgery, which makes it a little over 2 years. I love seeing her and she is my favorite doctor. Very nice and compassionate and always takes the time to listen even though you may have to wait a long time to see her. I also like her nurse assistant a lot, I love talking with her just as much, and the NA has had a cervical fusion (2x) before as well so she can understand. She works in the same office as my neurosurgeon and I was referred to her by him. She is technically a physical medicine and rehabilitation doctor. I usually see her every 2-3 months. Right now I am on medical leave from work so I see her every 4 weeks.

So here is the long story........

During my appointment in June I had been prescribed Three 100mg capsules of Gabapentin to be taken per day. After a few weeks of noticing nothing positive or negative I called the office and was told I could take up to 900mg per day split up 3 ways. I attempted 300mg 3x per day but the side effects of feeling dizzy, lethargic, and mentally slow were too much to bare. So then I started taking 100mg in the am, 100mg in the afternoon and 300mg at bed time. After a couple weeks of that I started taking 100mg in the am, 200mg in the afternoon and 300mg at bed time. This has worked moderately well, and the side effects are slowly going away, either that or I am getting used to it. This was discussed during my appointment on Monday, September 9th. The Doctor and I discussed 300mg capsules and both agreed this would be too much at this point due to side effects so she would prescribe me 100mg capsules and I could take up to 900mg per day split into three or four doses by slowly working myself up to that amount.

After I left I looked at my script and it stated, “Take one capsule by oral route 3-4 times per day”, quantity of 120. This is only a total of 400mg per day. Less than the 600mg per day I have currently been taking over the last few weeks.

I called the office and the NA gave me a call back... again we usually have a great relationship. I explained the situation to her and she talked to the Doctor and then said the Doctor said to slowly titrate up. I told her that I know... and the dr knows I have been taking 600 mg per day and she wants me to go to 900mg, but this current script is written for 400mg per day, so I am going to run out very early. Then she flips out (literally) and in a very rude loud tone says she is not here to argue she just told me what the Doctor said. As a restaurant manager I am used to customers flipping out and I know how to handle that. So I calmly said "(her name) I apologize if I am coming across as arguing, I am not trying to argue. I believe the three of us have a miscommunication, let me explain to you from the beginning." So I did. So then she says ok let me talk to the Doctor and then she comes back on the phone and says the Doctor will call in 180 instead of 120. I said ok thank you for your time and that was it.

So I go to the pharmacy to pick up the script and it was take 1 capsule by mouth 3-4 times a day. Exactly what the other script was! Then it said 180 was called in but of course they only fill a month max (unless its a 3 mo script of course)
Here is where the problem lies. (which I explained calmly to the NA) 4x30= 120. Because the script was written this way my insurance company will only pay for one Gabapentin (or any type of medication) script per month. Even though the Doctor has given the verbal approval to take up to 800mgs per day split into 3-4 doses and will write another script when I need it (according to the NA) my insurance company will not pay for it. My only option would be to have it refilled early, have the pharmacy staff look at me like a druggie that does not take my medication as prescribed, wait for the pharmacy to call the office to confirm the early refill (which will take a while), and then have to pay for the medication out of pocket.

Of course I do not know about the legalities and formalities of script writing, however, if the script was written take “take 2 capsules by oral route 3-4 times per day”, that would be a total of 800mg per day or 8 pills, so even if they wanted to do a two week supply 8x14 = 112, Or a 3 week supply at 8x21= 168 I would not have any problems with the insurance company or the pharmacy. I would have to pay another 10 dollar co pay, which I am fine with, I just wouldn’t be able to pay for the entire new script out of pocket which is what I am going to have to do now because I am not calling back up and trying to explain how to write a script. If it was written as stated above the insurance company and pharmacy would have no problem refilling or filling another script.

Sorry this is so long. Does anyone understand why the Doctor would want to write it this way. Does anyone understand why this is even a big deal... We are not talking about Oxycontin or something, its Gabapentin. I have had a great relationship with the dr and NA for 2 years and have only once asked for stronger pain meds. I have done PT, Injections, tried many meds and whatever else they ask of me. She has offered me stronger meds many times and I deny them because of my age and because I know I will probably need them in the future and can tolerate the level of pain I am at.

Anyway I know I am over thinking this. But can anyone give me some insight as to why she won't write the script for what she wants me to take? Why is it a big deal?

ACDF C4-5 June 23rd, 2011

Another surgery in the near future. I am 26 years old.

Current Meds- Norco 7.5/325, Cymbalta 60mg, Gabapentin, Adderall 20mg


  • is available in generic form , I would simply follow the instructions that the nurse gave you when she spoke to the doctor again.....or you can just follow the instructions of 600 mg per day for the 30 days and then revisit this subject when you see that doctor again in a month.....
    If you are just supposed to call when you need a refill, and since gabapentin is available as a generic, the cost should be very low, rather than several hundreds of dollars if you want to go ahead with the plan to increase the dose .
    This type of problem is one reason why patients should always check the prescriptions before you leave the office, otherwise trying to get this type of things straightened out over the phone, with more than the patient and the doctor into the discussion, usually results in miscommunication.
  • paininohioppaininohio Posts: 240
    edited 09/12/2013 - 9:03 AM
    Also, just a reminder to anyone, if you have AAA, they also have a medication discount program, if you end up having to pay for it out of pocket.
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  • AllMetalAAllMetal Posts: 1,189
    edited 09/12/2013 - 10:30 AM
    Gabapentin is the only medication I take currently, and I take different amounts on different days, depending on what I need. My doctor knows this, and like you, once I run out my I call my pharmacy (CVS) who calls my doctor who calls them back and I pick it up the next day. I've never had this take more than a business day. What I will say is that regardless of how my doctor writes my script (we've tried it different ways) my insurance will only pay for so many pills per month.... and at times I've had to take more than that amount in a month (Per my script) so I'd have to pay two copays. And although it isn't hundreds of dollars, it can still be $60.

    Good luck with your meds. I think at this point it is best to pay for the extra pills out of pocket this time to keep your good relationship with your pain management team in tact, and I'd discuss it again face to face... sometimes that's easier for everyone to understand.
    33yo mom of two. My surgical history...preadolescence scoliosis, kyphosis, and a hot mess.... 5 spine surgeries and lots of items added I wasn't born with (titanium, peek, surgical steel). Guess cremation is out. TSA loves me.
  • It might be an inconvenience, but the few times I have had an issue with a script being wrong, I've either made an appointment or if the schedule can't fit me in, then I go to the office and wait until someone talks with me. Going from receptionist to Rn to doc, is a chance for too many miscommunications. It's just not worth the hassle and almost always the hard feelings of getting into it with someone on the phone.

    I know this isn't always an option for people who live far away or who work, but if you can do it, then it's fixed because you have a face to face.
  • Thanks everyone for your helpful suggestions. I was just taken aback by the nurses behavior. She has had 2 cervical fusions her self and we often have private talks about different symptoms she has and things like that. I could get all my meds from my primary care with no problem, but continue to go to PM because I like her and my doc so much. I just couldn't believe the situation. I know they get very busy and overwhelmed. They are part of a multidisciplinary pain management practice and the business owner schedules appointments much too close together so they are always running behind, which of course makes patients angry (I never get angry and always laugh and say I would rather wait an hour for a good doctor than wait 1 minute for a doctor that does not spend enough time with his/her patients and does not listen.) I told my mom about this situation (we see the same Doctor) and she said that happened to her multiple times and she never understood why I like the nurse so much! Hmmmm. I am on short term disability right now, but I am used to working in a fast paced restaurant with nice and angry customers. If I ever spoke to a customer the way she spoke to me I would be in a lot of trouble. Thanks for your help. I most certainly will not be calling back up, but I do think I will ask her about it in private next time I see her.
    ACDF C4-5 June 23rd, 2011

    Another surgery in the near future. I am 26 years old.

    Current Meds- Norco 7.5/325, Cymbalta 60mg, Gabapentin, Adderall 20mg
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  • DonnabeDDonnabe Posts: 597
    edited 09/15/2013 - 2:34 PM
    I agree Chrissy- I think the office is quite disorganized and by the time the message gets to the doctor it is all messed up.... Ever play that game as a kid where you are sitting in a circle and one person says something and goes on to the next and the next and the next and by the time it gets to the last person it is all messed up!? I try to avoid that now by asking for either the doctor or the nurse to call me back and I usually just say its personal because I have had issues before. I will be checking every script before I leave! Unfortunately if I tried to make another appointment it would be at least a month. My next appt is scheduled for 4 weeks from my last because I am on medical leave from work, and that was even hard to get! I got the last appointment of the day added on making the day even longer for the staff!
    ACDF C4-5 June 23rd, 2011

    Another surgery in the near future. I am 26 years old.

    Current Meds- Norco 7.5/325, Cymbalta 60mg, Gabapentin, Adderall 20mg
  • ChrissysmomCChrissysmom Posts: 46
    edited 09/26/2013 - 5:48 PM
    Exactly, I was thinking of that game as I wrote it. I agree talking with her privately is the best thing. Ten to one there was another patient that she was angry at and you got the brunt of it. I too try and be patient and kind and usually end up joking around with doctor and staff. It also helps when needing something not run of the mill.

    I too learned the hard way to check every script before I left. My doc is over an hour away and I do NOT want to make that trip twice in the same day over a script mix up.
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