Why Follow Up Appointments Are Necessary

A study was presented last year at the headache scientific meeting that showed that almost 50% of patients who came to headache centers didn’t return for their follow ups.  I’m sure that there are many reasons for that and I will discuss some of those later.  I want to focus on one situation and is those patients who are quickly satisfied with their treatments and don’t return but wants us to continue the treatments.

We find ourselves faced with the situation where a patient comes in with a terrible headache problem, and may past treatment failures.  I pour my thoughts and soul into their troubles for 90 minutes, listening and trying to develop the perfect treatment program for them.  One facet of that may be a prevention medication. I then schedule them back in 3-4 weeks for two reasons. For one, to see if we are closer to our goal of 80% improvement and secondly to make sure they are taking the medication safely.  That’s my calling that people get well and that treatments are safe.

It is very common that the patient doesn’t show up for the follow up appointment, or cancels and then when the prescribed medication is gone, the pharmacy sends in a request for a refill.

This put us in a terrible situation. We are being asked to prescribe a medication blindly without knowing it is helping or if it is being taken safely.  The only way to do that assessment  as determined by health care standards, is to meet with the patient face to face, take their vital signs and listen careful for potential side effects.  We have no choice but to see a patient face to face.

When I deny the refill in these circumstances, it is quite common that the patient gets very angry.  I hate having any conflicts with patients because I’m in this business to help people get well and if they become angry at us, then from that point forward all our efforts are muted and that makes me very sad. But we have no choice in the matter. If we violate the standards of care we would be out of business very quickly.

I would never ask a patient to return without a good reason.  If someone is on a stable program and has met the 80% improvement mark then I can easily see them once a year for a check up (if I’m prescribing the medication) or I can turn their care back over to their primary care provider. We are very reasonable in this.

I have the sense that many of these patients who don’t come back after the initial appointment and then ask for refills is because they start the treatment program, are 30% better, and they are satisfied with that. Then they don’t want to take the time to come in but to just get their medications. But they could be 80% better if they would let me try.

Related to this issue are the patients who are 80% better and doing well but for whom I’m prescribing medications.  It is required by the legal standard of care if we are prescribing medications I must see you once a year.  I have no choice about that.  It isn’t me being mean or not caring (as a recent patient was screaming at me when it had been 16 months since I had seen them and they wanted refills), it is about the legal standards that we are required to follow and about providing medical care safely.

I simply ask you to understand the situation that we are in and please be kind. If you become angry at us, if you scream at Kaaren or me, it really ruins our day and makes us feel like just giving up sometimes.