The decision about whether to prescribe over the phone depends upon the physician's relationship with the patient, the type of medication, and the circumstances of the call.
Prescribing new medications to known patients over the phone without a recent clinical evaluation is not recommended, especially when a drug's appropriateness cannot be readily assessed. If such prescriptions are made by phone, the physician should document that the patient's clinical status and other medications have been assessed, that possible side effects were discussed, and that the patient was told under what circumstances to call again.
For prescription renewals by phone, an assessment of clinical status to check for side effects and the appropriateness of continuing the medication is important and should be documented in the patient's record. When prescribing controlled substances over a long period of time to a patient whose disease process is stable, the BRM recommends that the physician see the patient at least once every six months. For patients who are using Schedule II substances, the Board recommends that the physician see these patients as often as possible and clinically re-evaluate the patient at least every four months.
The circumstances of an out-of-state call is an important consideration. For the patient "caught" without his or her current medication, prescribing an amount to cover the limited time period may be appropriate. When the symptoms description suggests the need for a new medication, referral to a local emergency room or clinic for assessment is advised.
Special circumstances may develop where patients are being followed out-of-state because of the nature of their illnesses and the expertise of the physician. However, the involvement of a local physician who can monitor the patient and prescribe the needed medications as well, would still be important in these cases.
New or Lapsed Patients
Extreme caution should be exercised in prescribing medications over the phone to new patients or those who have not been clinically evaluated for some time. When suspicions of drug abuse are aroused, careful questioning, prescribing only alternative drugs, suggesting the patient be seen in a clinic or emergency room, and/or prescribing the smallest possible quantity are ways to deter inappropriate use.