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"Sir, I am sympathetic. But Viagra is generally prescribed by the clinic doctors. And your list of medications is so long that I am concerned about drug interactions. And....it has only been three weeks since your bypass surgery."
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"Look. We go back quite a ways. I know you are dealing with some difficult issues. But you do see how the results of your urine drug screen make it impossible for me to refill those missing prescriptions...."
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"The closest tertiary care hospital is 30 minutes by air. I promise that your member will get there alive. Your preferred center is at least 90 minutes away. He won't make it."
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I did my medical training at the very tail end of the era where physicians were expected to be the final word in all health care matters. Now with greater patient autonomy and considerably more bureaucracy that is not always so. But the isomer of "the doctor is always right" is not "the patient (or in the last instance, the insurance company) is always right". We need to remember the basic principle of "first do no harm". Sometimes it has to just be shortened to "no".
That last one is one I hope I never hear.
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