Prescription medication question

[atyclb]

someone i know was seen twice by a doctor at a bkk hospital. mri scan showed significant acute injury. associated nerve pain and muscle weakness. continues at same hospital getting physical therapy. asked nurses if doctor could refill prescription and they they say must re-register, pay consult fee again to renew rx.

 

is this normal?  in usa if there is doctor patient relationship it is no problem to ask for rx refill even call it in.  already done expensive multiple tests and know whats going on.   seems the extra appt will be the patient repotring continued pain and magically will refill the prescription.  is this a ploy to generate more money?

[lopburi3]

You are talking about medications only available from a hospital?  There is no need for prescriptions to buy most medications from drug stores here.  So that would be highly restricted types and only a limited number provided and a new visit would be required to obtain more.  

[blackcab]

Yes.

[atyclb]

codeine, a not particularly exciting medication, even a great cough suppressant.  the argument is there is a mri scan that shows multiple levels of spinal nerve damage, a no brainer for physicians according to a friend of mine that is licensed as a doctor in usa. codeine is commonly called in a a rx and could be renewed by the same doctor to be filled at the same hospital pharmacy. it is the opinion of the person i know who has been a us licensed md for decades that given the case and crystal clear nerve involvement and muscle weakness that a repeat office visit is a way to get more unnecessarily.

[Here2008]

22 minutes ago, atyclb said:

 

codeine, a not particularly exciting medication

 

Codeine is a restricted medication in Thailand. It is only ever supplied in very limited quantities (if at all) and only by prescription from a hospital pharmacy. In Thailand prescriptions for restricted medications  are not "refillable" without a medical consultation. 

[Bang Bang]

2 hours ago, atyclb said:

codeine, a not particularly exciting medication, even a great cough suppressant.  the argument is there is a mri scan that shows multiple levels of spinal nerve damage, a no brainer for physicians according to a friend of mine that is licensed as a doctor in usa. codeine is commonly called in a a rx and could be renewed by the same doctor to be filled at the same hospital pharmacy. it is the opinion of the person i know who has been a us licensed md for decades that given the case and crystal clear nerve involvement and muscle weakness that a repeat office visit is a way to get more unnecessarily.

Codeine is an addictive opioid. It's the doctor's prerogative to see the patient again before refilling. In fact, as Here2008 says it might even be malpractice for him to not do so.

 

"it is the opinion of the person i know who has been a us licensed md for decades that given the case and crystal clear nerve involvement and muscle weakness that a repeat office visit is a way to get more unnecessarily."

So this MD in the US is passing judgment on a Thai counterpart without knowing what rules apply here. The medical term for such a person is rectal orifice.

Edited August 5, 2017 by Bang Bang

[atyclb]

11 hours ago, Bang Bang said:

Codeine is an addictive opioid. It's the doctor's prerogative to see the patient again before refilling. In fact, as Here2008 says it might even be malpractice for him to not do so.

 

"it is the opinion of the person i know who has been a us licensed md for decades that given the case and crystal clear nerve involvement and muscle weakness that a repeat office visit is a way to get more unnecessarily."

So this MD in the US is passing judgment on a Thai counterpart without knowing what rules apply here. The medical term for such a person is rectal orifice.

  cool .  shared your thought with the us md and the person with the injury.  the md said try calling the doctor directly as his patient and he very well would have no problem refilling it. it seems to be the robotically thinking nurse at first base.

[Here2008]

Thai MDs follow Thai laws/regulations in respect of controlled medications. if you care to check the American system is now desperately attempting to stuff the genie of poor prescribing practice/addict creation back into the bottle. Those who prefer the American system know what to do -- It involves LEAVING Thailand.

[lopburi3]

As said this is Thailand.  You register at hospital one time - but you (he), or family member who can report on his conditions, would need to meet with doctor for new medication issue in our experience (we obtain medications for upcountry relative using this method).  So yes the normal hospital fee of several hundred baht plus doctor consultation would be due each time.

[Here2008]

Just now, lopburi3 said:

but you (he), or family member who can report on his conditions, would need to meet with doctor for new medication issue in our experience (we obtain medications for upcountry relative using this method)

Yes but  I doubt that a continuing supply of narcotic medication could be obtained using this method. 

[atyclb]

29 minutes ago, Here2008 said:

Thai MDs follow Thai laws/regulations in respect of controlled medications. if you care to check the American system is now desperately attempting to stuff the genie of poor prescribing practice/addict creation back into the bottle. Those who prefer the American system know what to do -- It involves LEAVING Thailand.

 

 

cn you please provide url to thai law stating an office visit is legally required to renew controlled substance.  per some research and feedback from the us md there are usa medical practices aka doctors that run drug mills that actually see repeat patients usually at an extraordinarily high per hour rate and refill controlled substances and earning considerable money. this is an example of insisting to see a patient to collect the office visit fee.  yes docs that do this are unscrupulous. 

Edited August 6, 2017 by atyclb

[Here2008]

18 minutes ago, atyclb said:

 

 

cn you please provide url to thai law stating an office visit is legally required to renew controlled substance.  per some research and feedback from the us md there are usa medical practices aka doctors that run drug mills that actually see repeat patients usually at an extraordinarily high per hour rate and refill controlled substances and earning considerable money. this is an example of insisting to see a patient to collect the office visit fee.  yes docs that do this are unscrupulous. 

Here !  https://www.cdc.gov/drugoverdose/data/prescribing.html  A good exposa of very poor US 'medical' practice which has led directly to an increasing  population  of addicts and a souring narcotic related death rate.

 

As already stated if your 'friend' requires a prescription for  narcotic medication in Thailand he must make an appointment with a doctor.  And yes a consultation fee will be payable. 

[atyclb]

41 minutes ago, Here2008 said:

Here !  https://www.cdc.gov/drugoverdose/data/prescribing.html  A good exposa of very poor US 'medical' practice which has led directly to an increasing  population  of addicts and a souring narcotic related death rate.

 

As already stated if your 'friend' requires a prescription for  narcotic medication in Thailand he must make an appointment with a doctor.  And yes a consultation fee will be payable. 

 

the cdc url is interesting but please post the url for thailand prescribing law

[atyclb]

1 hour ago, Here2008 said:

Yes but  I doubt that a continuing supply of narcotic medication could be obtained using this method. 

 

 

not so.  review this specifically about thai hospitals

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3931245/

[Here2008]

6 minutes ago, atyclb said:

 

1 hour ago, Here2008 said:

Yes but  I doubt that a continuing supply of narcotic medication could be obtained using this method. 

 

 

not so.  review this specifically about thai hospitals

 

I think it is you who needs to read and more importantly understand that ! 

 

***  Nearly all of the hospitals need the doctors to sign a special form for every single patient visit (96.4%). ***  (Extract from the supplied link)

Edited August 6, 2017 by Here2008
typo removed

[atyclb]

5 minutes ago, Here2008 said:

I think it is you who needs to read and more importantly understand that ! 

 

***  Nearly all of the hospitals need the doctors to sign a special form for every single patient visit (96.4%). *** 

 

the actual entire paragraph reads

 

"

Nearly all of the hospitals need the doctors to sign a special form for every single patient visit (96.4%). However, some community hospitals used other patterns. Ten community hospitals permit doctors to sign only on the first visit, thereafter the nurses can prescribe under doctor supervision. Only two community hospitals and one medical school hospital do not require the doctor to sign a special form."

 

 

the post i responded to was about if family or caregivers can pick up medications on behalf of sick people

 

"From Table 5, many hospitals permit caregivers to receive oral opioids on behalf of patients (36.7%). In contrast, some hospitals totally prohibit the caregivers to receive oral opioids on behalf of patients (22.1%). "

Edited August 6, 2017 by atyclb

[lopburi3]

I'm off this train 

Edited August 6, 2017 by lopburi3

[Here2008]

 

Posted 3 minutes ago (edited)

  5 minutes ago, Here2008 said:

I think it is you who needs to read and more importantly understand that ! 

 

***  Nearly all of the hospitals need the doctors to sign a special form for every single patient visit (96.4%). ***

 

the post i responded to was about if family or caregivers can pick up medications on behalf of  terminally  sick people. I fixed it for you because you seem to have missed the fact that the article you cite is about Palliative care!   

 

Edited August 6, 2017 by Here2008
typo removed

[atyclb]

1 hour ago, Here2008 said:

 

Posted 3 minutes ago (edited)

  5 minutes ago, Here2008 said:

I think it is you who needs to read and more importantly understand that ! 

 

***  Nearly all of the hospitals need the doctors to sign a special form for every single patient visit (96.4%). ***

 

the post i responded to was about if family or caregivers can pick up medications on behalf of  terminally  sick people. I fixed it for you because you seem to have missed the fact that the article you cite is about Palliative care!   

 

 

dont fix it for me, fix it because because of you. 

[bkk6060]

Sorry, it seems many are unaware of what goes on here.  I can buy Codeine readily over the counter at several pharmacies in Pattaya.

Tramadol, codiene, valuim no problem.

[atyclb]

On 8/6/2017 at 3:05 PM, Here2008 said:

 

Posted 3 minutes ago (edited)

  5 minutes ago, Here2008 said:

I think it is you who needs to read and more importantly understand that ! 

 

***  Nearly all of the hospitals need the doctors to sign a special form for every single patient visit (96.4%). ***

 

the post i responded to was about if family or caregivers can pick up medications on behalf of  terminally  sick people. I fixed it for you because you seem to have missed the fact that the article you cite is about Palliative care!   

 

 

 

since when are terminally ill people not classified as "sick people". Other diseases like RA to cite one can and do receive palliative care.

 

out of curiosity do you have healthcare background?

[atyclb]

4 hours ago, bkk6060 said:

Sorry, it seems many are unaware of what goes on here.  I can buy Codeine readily over the counter at several pharmacies in Pattaya.

Tramadol, codiene, valuim no problem.

 

the option also is to go to a government hospital non specialist general medical clinic where the consult fee is much less and result same.

[atyclb]

and now the definitive answer to the dilemma in the op; doctor confirmed that nurse could have/ should have contacted him and or left a message on his system about patient and without any ado would have indeed renewed the prescription, yes, without an additional office visit-consult.

 

this confirms what my usa doctor friend thought aka "no brainer" but the problem in thailand is that "no brainer" takes on enhanced meanings.   could be lazy nurse or robotic limited thinking ability or even hospital internal agenda to generate more income.

Edited August 10, 2017 by atyclb