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Friday, October 15, 2010

How to Get Your Doctor to Help You Stockpile Medicine, by Cynthia J. Koelker, MD

Various pills

Picture this: Your doctor enters the room and asks, “How can I help you today?”
“I’d like enough medicine to survive the end of the world as we know it,” you reply.
He narrows his eyes and responds, “Just how much Prozac would you need?”
. . .
Finding a physician to help you stockpile medications will be a challenge. Unless your doctor, too, believes Armageddon is nigh, he’s not likely to grant your request.
Why not? Doctors are responsible for the medications we prescribe and the consequences, intended or unintended. Remember, every medication is a potential poison. You’re probably glad your own physician has sufficient training to possess a valid medical license. Certain problems (and medications) require periodic monitoring regarding their effects on the human body. No doctor wants to be responsible for patients who won’t comply with essential examination and testing. Would a car maker warranty your automobile engine if you refuse to change the oil?
Typically, doctors prescribe enough medication to cover a specific problem for an appropriate length of time. Antibiotics are usually dispensed for 7 to 10 days, blood pressure medicines for 1 to 6 months, diabetic medicines for 1 to 3 months, and pain relievers until the underlying problem has resolved.
Does your doctor prescribe you extra amoxicillin, just in case you get sick later this year? Not likely. When physicians prescribe more medication than is currently necessary, this often amounts to patients playing doctor with themselves or with others. Under our current system, this can be a felony.
At TEOTWAWKI, many survivors will be their own doctor, like it or not. And to do so, you will need a stockpile of medications.
Before I offer advice on how to get your doctor to help you with this stockpile, please realize that there are other obstacles to the acquisition of said drugs. Pharmacists have the right to refuse to fill a prescription that seems unreasonable or potentially harmful. Insurance companies usually limit payments for prescriptions to a 1 to 3 month period at a time. You’ll have to pay out of your own pocket to get more medicine than this. Doctors cannot legally alter their prescriptions to say you are taking more medication than you actually are. Neither would it be ethical for you to lie about the situation.
So, how to get the medicine that you may need?
One option is to convince your doctor that the end of the world is near. That’ll be tough. But think a moment, if your doctor really did think TEOTWAWKI is around the corner, he’d be doing his best to help you prepare.
Doctors do prescribe extra medication, along with directions for use, under special circumstances: antibiotics for potential traveler’s diarrhea, anti-malarials for travel to Africa, six months of medications if you’ll be wintering in Antarctica. Asking for medications for TEOTWAWKI is akin to doing the same for a trip around the world. The way I see it, such a supply would be intended to span a gap of only a year or two only. Some medications probably do have a shelf-life of a decade beyond their expiration date, but hopefully a better solution would be available long before then.
Convincing your doctor to prescribe extra medication depends largely on the doctor-patient relationship. If your doctor trusts you, he or she is much more likely to assist you. Please realize that your doctor will think that he’s doing you a fairly large favor. He may even question the legality of his own prescribing. Don’t forget to be grateful. Also realize that even if a doctor writes more than a year’s worth of refills, pharmacists cannot fill them beyond a year of the original prescribing date. If you are convinced that you need more than a 12-month supply stockpiled, you’ll need to discuss this openly with your doctor. Obviously a person could visit more than one doctor, which I don’t recommend, especially if you don’t tell each and every one of your physicians what you are doing. Dishonesty is a deal-breaker when it comes to getting your doctor to trust you.
In general, medications are prescribed for either acute problems or chronic problems. Acute problems include most infections and injuries. Chronic problems include asthma, diabetes, heart disease, hypothyroidism, mental illness, arthritis, and a host of others. Treatment of chronic conditions also includes modification of risk factors including high cholesterol and high blood pressure. Even antibiotics are sometimes prescribed long-term in certain situations, e.g. acne, rosacea, certain forms of colitis, and recurrent urinary infections.
Medications for acute problems include antibiotics, anti-virals, anti-malarials, antifungals, anti-diarrheals, antiemetics, migraine treatments, pain medications, heartburn relief, albuterol for asthma and COPD, nitroglycerin, corticosteroids, and anti-inflammatories, to name the most common.
Drugs for chronic problems and conditions include birth control pills, antidepressants, allergy medications, inhalers for asthma and COPD, anti-anginal drugs, acid-reducing drugs (proton pump inhibitors, histamine-2 blockers), anti-inflammatories, diabetic meds, thyroid replacement, and many others.
Without specifying which of these meds I’d advise for stockpiling, I’ll tell you exactly how I’d like a patient to approach me to acquire an extra supply, an approach which I believe would work for other doctors as well.
First, begin establishing a trusting relationship with your doctor. If you don’t think your physician even knows who you are, make an appointment for a minor problem. Don't ask about stockpiling at this initial visit.
If your doctor asks you to follow-up for this problem, then do so. Follow directions. Be responsible. If he says no follow-up is needed, no doubt you can find another reason to come in within a month or so. Accompany another family member to their appointment to keep your face fresh in your doctor’s memory. If there are multiple providers in your physician’s office, try to see the same one each time to establish a relationship.
By the third time your doctor has seen you within a time frame of a few months, he’s going to start knowing you, and more importantly, trusting you. You must act in a trustworthy manner by:
  • Showing up for your appointments
  • Not canceling appointments with insufficient warning
  • Arriving on time (even if you must wait on the doctor)
  • Taking your medications properly and knowing their correct names and dosing
  • Trying to do your part in every way
  • Being kind, pleasant, polite, and cheerful.
Of course, this is good advice even if TEOTWAWKI does not occur in our lifetime.
After doing the above, it’s time to consider approaching the topic of TEOTWAWKI.
Say that you have diabetes and want to be prepared. If you ask for a year’s prescription, your doctor may figure you won’t show up again, even though you’ve demonstrated responsibility to date. Ask for an extra three months instead and make 100% sure that you show up for your next scheduled visit. If you don’t, your doctor will decide he cannot trust you. As in every relationship, once trust is broken, it takes much, much longer to reestablish.
Assuming you do keep your scheduled follow-up, remind the doctor that you have put back the extra medication, and that you’d like to have an additional three month’s worth. Reassure him that you will again follow-up whenever he’d like you to return. (And especially for diabetics, do what your doctor suggests regarding blood sugar testing, weight loss, etc. – at the very least, try.) In this fashion by establishing and confirming trust, you can build up an adequate stockpile. If your relationship is strong, he may trust you to get even a year’s worth ahead of time. The same protocol would apply equally well to any of the chronic diseases mentioned above. And if you suffer from any of these, educating yourself is an excellent idea. Learn how to take care of yourself now so you’ll be ready later.
For acute problems, such as bacterial infections, you’ll want a supply of antibiotics on hand. Follow the above directions in establishing a trusting relationship. Then either when you are sick (or when you are not) ask for a supply of one appropriate antibiotic, perhaps a 30-day supply. Reassure your doctor that you will not use this medication as long as he is here to take care of you. If you get sick again, go back to your doctor and remind him of your plan. If he suggests antibiotics, request a new prescription, and perhaps another supply to stockpile. Trust, trust, trust. That’s 99% of the equation.
With 2012 just around the corner, you should start now. None of us knows God’s timeline, but waiting until the last minute is ill-advised.
* * *
What do Armageddon and health reform have in common? Either way, people need to know how to care of themselves with the resources at hand. Written by family physician Cynthia J. Koelker, MD, 101 Ways to Save Money on Health Care explains how to treat over 30 common medical conditions economically, and includes dozens of sections on treating yourself. Available for under $10 online, the book offers practical advice on treating: respiratory infections, pink eye, sore throats, nausea, diarrhea, heartburn, urinary infections, allergies, arthritis, acne, hemorrhoids, dermatitis, skin infection, lacerations, lice, carpal tunnel syndrome, warts, mental illness, asthma, COPD, depression, diabetes, enlarged prostate, high blood pressure, high cholesterol, and much more.
Dr. Koelker has recently started a new medical blog on surviving 2012 and TEOTWAWKI, There is not much posted there yet, but there will be, as she begins answering questions from readers. She welcomes your questions, comments, and critiques.

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