We do tell the patient to bring all pill bottles to each visit, and really push to make this happen. It is astounding how many ways there are to have it go wrong between how I think the patient is taking a medication and what is actually passing their lips. The MA checks the pill bottles against the chart every time.
We are not absolutely rigid about our policy, but I want to hear directly from the patient why he/she needs a refill. Sometimes the pharmacy only gave part of the Rx I had written, for example, or their insurance only paid for 30 days instead of 90. If the patient just could not get an appointment and the prescription had run out, we refill until the appointment that we then make sure is scheduled. Our after hours calls get handled by the Providence triage service, and they don't refill prescriptions.
I previously was in a coverage schedule with another busy doctor who encouraged pharmacies to call him nights and weekends for refills. It was a nightmare. When I got out of that schedule and we got firm with our policy, it was surprising how quickly everyone adjusted, and with very little pushback. I get my personal meds from a mail order pharmacy, and it is just not that tough to see when the bottle is getting empty to arrange to get more, nor is it hard to read the label and see "0 refills" and know I need to be making an appointment.
