Family, Internal Medicine, General Medical Questions/Advice on Prescription


Hi Doc

Wanted to get your opinion on a situation with my primary, regarding whether he should have called me in a prescription.

I have been going to Heritage Medical Associates in Nashville for 15-20 years. One of the largest practices in Nashville with many different specialties. My current primary with Heritage I have been seeing for 10-12 years at least.

I’m 66, 5'7", 165lbs, no major health issues, just typical prostate, gerd stuff which I take terazosin & pantoprazole for, and lumbar degenerative disc which I’ve had for 20 years; take Tramadol for that but only 3-4 a WEEK. Now, I’ve had bronchitis or URI twice in the last 2 years; and my symptoms are always the same, and my current primary has prescribed an antibiotic in the past, a Z-pac as I recall, or maybe amoxycillin.

I called their office this past Friday at 3:50pm, thinking I would get their answering service because I thought they closed at noon on Friday. But my docs receptionist/nurse answered and I asked her if Dr. Smithson would call me in something for my symptoms, since it was obviously too late to see him.

Told her I started with a sore throat Thursday, coughing up clear phlegm, felt lethargic. Friday, my cough had progressed so that it kept me awake most of Thurs night/Friday morning and I was productive, coughing up thick, large, brown phlegm. Severely lethargic, no appetite, no fever at that time, chest felt tight and hurt slightly when I inhaled deeply, and my quads ached badly.

I said I wanted to see if he would call me in something so I wouldn’t have to go 2 more days without antibiotics before coming to his office, since I was getting worse and my symptoms were identical to what I had presented in the past. She called me back and said he prefers you go to a walk-in clinic or emergency room.

So he refused to call me in a ‘script. Pissed me off big time. It’s not like I was asking for a scheduled drug, just a antibiotic, which he had already prescribed in the past for similar symptoms.

I’m looking for another primary because I don’t think his actions were reasonable, considering the fact that I have been his patient so long, that I have no major health issues that could be a concern for “diagnosing” over the phone, and that I only take 3 prescription meds, 2 of which are both low-risk for drug interaction and the third I take infrequently. Yes, I know Tramadol is a schedule IV but I obviously don’t abuse it at 4 a week.

So, my question is, would you have prescribed something over the phone if I were your patient? BTW, I did go to a clinic Saturday with a 102 temp, and I had severe URI. Gave me Z-pac & Benzonatate.

I don’t want to let my anger override my common sense here if I’m wrong. I know things have changed drastically for physicians in just the last 3-4 years. But, this is the second time he has refused to write me a ‘script; the other time, about 4 months ago, was for Tramadol for my degenerative disc. BUT, he had written a ‘script for me for Tramadol about a year prior; this time he said, “we’re not set-up for that. I’d rather refer you to a pain management specialist.” I understand there is a lot of concern today about Tramadol. And if he was concerned about abuse, he can tell the next time I ask for a refill if I’ve been abusing, so I don’t know why he wouldn’t prescribe. Had to go to my orthopedic for ‘script. I have told my primary I only take Tramadol on Friday/Saturday because I cut/trim my yard, my daughter’s and my father-in-law’s. I take two Friday and two Saturday….16 a month. Hardly a candidate for drug abuse. And again, he can track that by the refills I request.

Thanks so much, Doc.
Nashville, TN

Dear Don,

It seems your anger is coming from the fact that you did not ask for a scheduled drug, but an antibiotic. It is unusual for me to prescribe an antibiotic over the phone without seeing the patient and this is why:

1). Most of the time a common cold will last for 6 days. This is a virus and an antibiotic will not work, but it will cause antibiotic resistance including a host of possible side effects including clostridium difficile.

2). If the symptoms exceed the 6 days, the infection can be sinusitis or bronchitis. Both present the same way. Only a physical exam will deferentiate between the two.

3). Too many providers prescribe the Z pack for sinusitis when it is actually resistant to much of the bacteria that causes this infection. This is because too many providers called in prescriptions over the phone without knowing what they were treating.

4). Sinusitis and bronchitis are treated with different antibiotics and therefore need to be diagnosed properly.

So my answer is no. I would not have prescribed the antibiotic over the phone. The fact that you called the office on a Friday, thinking they were closed, leads me to believe you were not sick enough to go to the office to begin with. This is how I practice medicine. I think you should re-think your reason for leaving this provider. It seems that he is prescribing appropriately. If you're looking for someone to prescribe at your whim, I am certain you can find many providers. But, do not blame them when you develop an infection due to inappropriate antibiotic prescribing habits that land you in the hospital for overgrowth of bacteria.  

Family, Internal Medicine, General Medical Questions

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Dr. Pamela M. Cipriano, DNP, APRN


My name is Dr. Cipriano. I have a private practice specializing in adult health and wellness. I can answer questions associated with thyroid disease, cardiac disease, pulmonary disease, high blood pressure, muscular aches and pains, cholesterol levels, male/female sexual questions or questions on the sexual organs, gastrointestinal problems, healthy ways to lose weight and maintain a healthy lifestyle, and nearly anything else that pertains to medicine.


I am on the Medical Staff at a local hospital where I work as a medical/surgical hospitalist as well as in the emergency department. I am certified in critical care and advanced cardiac life support. Prior to becoming a Nurse Practitioner, I was a certified critical care nurse (CCRN).

Society of Hospital Medicine American Association of Critical Care Nurses American Association of Nurse Practitioners Connecticut Advance Nurse Practitioner Society

Maryville University 2014-2016 Doctor of Nursing Practice University of Connecticut 2007-2011 MSN, Acute Care Track Nurse Practitioner. Board Certified September 2011 Critical Care Certified 2014 Central Connecticut State University 2002-2006 BA Psychology St. Mary's Hospital School of Nursing 1991-1993 Diploma Nursing Registered Nurse

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