I have read many of the pharm rep discussions on Family L over a number of years. Seems to me that these reps can beg, barter, and cajole, but physicians still have the ability to make decisions.
I have in my hand other letters directed to me personally from Medcohealth, Caremark, Medicaid (your choice). These letters have veiled or real threats directed toward me or my patients. In some cases it is now impossible to even talk to a human regarding some of these letters or decisions that have been made.
Why do we discuss repeatedly the conspiracy theories of profit related to drug reps when we have real and everyday evidence of harm done to us, our reputations, our ability to practice medicine, and our patients, by these so-called "pharmaceutical health" programs?
If you think that drug company sponsorship of studies has some amount of bias, this is nothing compared to government-sponsored, accounting-based, budget-slashing ventures that somehow gain acceptance as research. These have resulted in real and present danger to our patients, insured, Medicaid and otherwise.
Because of who we are in Family Medicine, who our patients are, and how we practice, these efforts hurt us greatly.
When I read fine print statements like this I want to vomit. "Medco Health recognizes that only treating physicians can make prescribing decisions. We hope this supports patient use of safe, effective medications they need to stay healthy at a cost that's most affordable." "The plan sponsors are also concerned that direct to consumer advertising is causing unwarranted demand. In the even that your patient is being treated for seasonal allergies or other allergic conditions, which do not require daily dosing for extended periods of time, please consider writing future prescriptions, including refill authorization, for smaller quantities of medication." "Please consider OTC antihistamines, such as diphenhydramine or loratadine, for patients requiring as needed therapy." "Such actions help preserve the affordability of your patient's drug benefit."
"I suspect the same folks would attempt to convince a town that hexavalent Chromium is beneficial, at least this is the impact these statements have on me after recently watching Erin Brockovich. " addendum by RCB after the posting.
Antihistamines are the least of my worries. There is much more at risk.
Just because antihistamines, non-steroidals, ulcer meds, and mental health drugs are at the leading edge of the tidal wave of health care costs does not mean that they should receive all of the attention. Patients who just happen to need these medications are an emerging class of people facing discrimination. At risk are kids, the elderly, those whose jobs depend on high performance, those who need medications to function physically or mentally, and those who could die if they do not have such medications. The impact on patients is often small compared to the impacts on those around them in families, neighborhoods, or communities. The impacts occur in out of pocket costs, transportation, lost time on phone calls and paperwork, and more.
A core value of physicians is to defer their own needs over that of patients. Obviously these companies have no such motivation. Their recommendations take up valuable time of physicians, our nurses, and our patients and provide rare if any benefit regarding health care quality. Our good-natured amiability in family medicine seems to keep us from addressing this growing problem.
Recommendations:
1. If you think some of the M.D.s signing their names to such trash have gone too far, I hope that you take the step of reporting them to physician licensure boards, if indeed they still have such a privilege in their possession. I hope that you give medical directors of such efforts enough reality to help these positions stay as vacant as possible.
2. If you are considering such a position, please reconsider. The comfort and extra salary cannot replace the potential damage you will do to others and to your own reputation.
3. Any study done on cost savings that does not include a global approach to evaluation (beyond dollars saved in the prescription category alone), is a worthless study. This means all but a handful.
More and more I see things in terms of pushing costs off to someone else, usually a future generation. I think we in Family Medicine are in a position to see the impacts on society such as education, persistent poverty, hopelessness, prisons, mental disability, etc.
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We need medical leaders who will call such programs and medical directors to accountability.·
We need government leaders who will anticipate future impacts of decisions as well as dealing with current budgetary crises.·
Most of all we need a people who will accept some amount of sacrifice on their part for the good of those most in need, We need leaders in the media which will help us to understand that such sacrifice is really a vote for a better life for all.·
God's worst punishments to nations did not come about because the people increasingly chose wickedness. Obliteration and exile came about because the people stopped caring for others.Health programs that put caring and care at risk have no place in medicine. I happen to think that most drug reps actually care about our patients. I am certain that most of the prescription plans do not.
Family medicine needs physicians who care, who are willing to be advocates for patients, at all levels. Our efforts in these areas might also attract students and residents who share such values. Frankly I see no other group of physician with the motive, opportunity, and means to do so.
Robert C. Bowman, M.D.
rcbowman@atsu.edu
Addendum from Health Prof posting -
Intro - Some of this debate in college education strikes a chord regarding medical education. Not many years ago, connections with for-profits, patents, and business deals were considered grounds to dismiss faculty. Now they are major sources of income and drive medical schools toward research, MD/PHD, NIH grants, and more. Information sales are a big portion of medical associations.
The early phase of commercialization of college has now moved into a more active phase, with profits to be made off students and university resources.
PS added at the end
Since you are also participants in the health care-insurance-government coalition plans, you might also want to know what is going on. A major factor in medical student choices away from primary care is the "hassle factor." Initially I thought that all physicians faced these problems. It is increasingly clear that this is not true. Specialists get better reimbursements and more employees to insulate them from such mundane tasks. Higher reimbursements allow and encourage this. This will increase as long as doctors can use staff to care for patients and get paid the full amount. When doctors are only paid for the time they actually care for patients, costs will become more reasonable.Dentistry is facing the same issues. According to recent national workforce committees, dentists average $122,000 for a 3 day week. Few dentists want to do basic dental "primary care." Most want to do cosmetic or other specialty work. TV Shows like Extreme Makeover are not going to help. One of our graduating dentists recently laughed at state folks attempting to enforce a 40 hr work week as necessary for meeting requirements for repayment of loans. There is little hope for dentists for rural or underserved areas. Other dental providers are making strong cases for better access to patients, the same ones that are doing much if not most of the dental care now. Without changes on the part of dentistry, they should have their way.
Primary care doctors continue to face mounds of paperwork regarding job issues, school issues, disability issues, prescription restrictions and denials, etc. These overwhelm us and our caring nurses and staff, who often relocate to work for specialists.