Countin' by 5s...

rxlea said:

Save the "douchebag" insults for the pre med forum. Please don't call my friends names.

You're not playing nice and you know it.

If docs weren't swayed by drug reps, then why would companies spend billions of dollars to send hot young men and women to talk to them? Why give the gifts?

You need only to look at some studies to see some of the shadiness going on with these "new" formulations of products. Those non-inferiority studies sure are enlightening, don't you think

And A4D pointed out some pretty significant ones. The evidence is quite compelling but not in the way you may think.

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Do you have a source for the "billions of dollars spent on hot young men and women"?
I only bit back because that poster got snarky and condescending with me only due to the title under my name. That is pure and unadultered crap, especially in a thread which had, up to that point, focused on collaboration and in which I had been peacefully contributing. I am not in any way discussing the drugs themselves and yes, the "non-inferiority" studies are often times very suspect and even sketchy. A lot of old docs fall victim to such publications and a good bit of our current training focuses on dissecting medical literature for just these reasons.

The only point here is that docs do not accept gifts (or if they do they do so at their own peril) This is actually very likely one driving factor for the rampant increase in drug advertisements. If they cant pay off the doctors any more they might as well convince the patient that they need the designer brand name drug.
http://www.kevinmd.com/blog/2009/10/ban-doctors-accepting-drug-company-gifts.html
http://www.boston.com/whitecoatnote...hAPBKGB66f1tAlI/story.html?rss_id=Top+Stories (a good one because it shows medical personnel getting bent about a potential laxing of the legal ban)
http://online.wsj.com/article/SB124640634767976599.html.html

interestingly, while looking around for examples of the gift ban, many of the sites had drug ads in the banner
The issue isnt that it cannot happen, but that it is just majorly against the rules. I am not in new england (where a couple of those links are from) but at my hospital you will incur disciplinary action for simply having a pen with a drug name on it. When it comes to gifts from drug reps the rule is a resounding "no"

All4MyDaughter said:

Whether physicians can receive gifts anymore or not is irrelevant. The new trick is to provide crap like copay cards or coupons to get physicians to write for the expensive new hotness. My little sister was given a copay card for a new cream that her son
"needed". The doc insisted it was "new and better." The name escapes me, but it was for a diaper dermatitis. That **** was over $100 and guess what was in it? Miconazole, zinc oxide and white petrolatum. Sheesh.

Another big offender lately has been Edari. No one writes for it, since there are so many cheaper options. But the copay cards and coupons come out and suddenly every doc in the area wants to use it, first line. It's all well and good until the cards/coupons are gone and the patient doesn't want to pay the $50 copay. And don't get me started on samples and how they negatively impact prescribing patterns.

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There is a lot of sketchiness that goes on but I disagree that it is irrelevant if the docs accept gifts. Tricking a doc into thinking some new drug is amazing with clever wording in a clinical trial is not the same as paying a doctor off to knowingly prescribe a drug for kick-backs.

rxlea said:

I've been out of retail a while. I didn't know coupon use had grown so much.

Oh please do tell our friend about samples!

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Im sure you'll get to the other post, but I just wanted to emphasize -
I am not saying that drugs are not promoted or that every drug that a doctor prescribes is always the best. I am well aware of a good many PCPs who give out samples rather than write a script. Some of these are actually done for the benefit of a patient who cannot afford a drug (although an argument could be made to parallel a drug dealer who gives freebies to hook a client )

I am only contesting the original notion of doctor kick-backs from writing scripts. That is far more malicious than reality. Sure, a drug rep may give a presentation on something and a good many docs will say "hell, seems legit " and start scripting away with the new drug. This is just fundamentally different than a drug rep giving a gift to a doc and the doctor prescribing that product in hopes of receiving future perks. That is all. The rest of the promotion tactics are perfectly debatable but do not have this same element of knowingly prescribing something for personal gain.

SpecterGT260 said:

Im sure you'll get to the other post, but I just wanted to emphasize -
I am not saying that drugs are not promoted or that every drug that a doctor prescribes is always the best. I am well aware of a good many PCPs who give out samples rather than write a script. Some of these are actually done for the benefit of a patient who cannot afford a drug (although an argument could be made to parallel a drug dealer who gives freebies to hook a client )

I am only contesting the original notion of doctor kick-backs from writing scripts. That is far more malicious than reality. Sure, a drug rep may give a presentation on something and a good many docs will say "hell, seems legit " and start scripting away with the new drug. This is just fundamentally different than a drug rep giving a gift to a doc and the doctor prescribing that product in hopes of receiving future perks. That is all. The rest of the promotion tactics are perfectly debatable but do not have this same element of knowingly prescribing something for personal gain.

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Who said anything about kickbacks? Cyclo just pointed out that reps bring in food. Which is still done, by the way, just in an "educational" context.

I went back and looked. I originally read "brought" as "bought" . Once upon a time expensive and extravagant dinners (trips and vacations too) were paid for by drug reps for doctors. I thought this is what was being suggested.
I guess if we are talking about this in just the context of exposure it all adds up fine. My bad

SpecterGT260 said:

Do you have a source for the "billions of dollars spent on hot young men and women"?
I only bit back because that poster got snarky and condescending with me only due to the title under my name. That is pure and unadultered crap, especially in a thread which had, up to that point, focused on collaboration and in which I had been peacefully contributing. I am not in any way discussing the drugs themselves and yes, the "non-inferiority" studies are often times very suspect and even sketchy. A lot of old docs fall victim to such publications and a good bit of our current training focuses on dissecting medical literature for just these reasons.

The only point here is that docs do not accept gifts (or if they do they do so at their own peril) This is actually very likely one driving factor for the rampant increase in drug advertisements. If they cant pay off the doctors any more they might as well convince the patient that they need the designer brand name drug.
http://www.kevinmd.com/blog/2009/10/ban-doctors-accepting-drug-company-gifts.html
http://www.boston.com/whitecoatnote...hAPBKGB66f1tAlI/story.html?rss_id=Top+Stories (a good one because it shows medical personnel getting bent about a potential laxing of the legal ban)
http://online.wsj.com/article/SB124640634767976599.html.html

interestingly, while looking around for examples of the gift ban, many of the sites had drug ads in the banner
The issue isnt that it cannot happen, but that it is just majorly against the rules. I am not in new england (where a couple of those links are from) but at my hospital you will incur disciplinary action for simply having a pen with a drug name on it. When it comes to gifts from drug reps the rule is a resounding "no"



There is a lot of sketchiness that goes on but I disagree that it is irrelevant if the docs accept gifts. Tricking a doc into thinking some new drug is amazing with clever wording in a clinical trial is not the same as paying a doctor off to knowingly prescribe a drug for kick-backs.

Click to expand...

I made that comment for emphasis. Drug companies do spend billions of dollars marketing their product. Drug reps are a part of that. I've never, ever seen an unattractive rep, btw. Have you? It's kind of the ongoing joke that they are good looking.

To your point, several institutions have begun to prohibit gifts, lunches, etc. That was not always the case, however. There are still plenty of institutions, PCPs, and others who accept gifts like t-shirts, pens, notepads. Once we were given makeup bags lol Our company has since prohibited any gifts but only in the last few years or so.

for some interesting reads (which may or may not be true), check out http://www.cafepharma.com/boards/ (drug rep msg board)

rxlea said:

http://www.economist.com/node/21558313?fsrc=nlw|wwb|7-5-2012|2691115|39276922

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Yea, after the abbott 1.5b a couple months back, I was sitting at an abbott dinner the other day thinking, "how can they still afford to do this?". I've not looked at any balance sheets on any of these kids as to avert stomach illness, but I'm guessing they must be quite large.

joetrisman said:

Yea, after the abbott 1.5b a couple months back, I was sitting at an abbott dinner the other day thinking, "how can they still afford to do this?". I've not looked at any balance sheets on any of these kids as to avert stomach illness, but I'm guessing they must be quite large.

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Oh I bet! And I'm right there with you on the stomach illness.

joetrisman said:

Yea, after the abbott 1.5b a couple months back, I was sitting at an abbott dinner the other day thinking, "how can they still afford to do this?". I've not looked at any balance sheets on any of these kids as to avert stomach illness, but I'm guessing they must be quite large.

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Drug rep dinners have ruined me on steaks in regular restaurants. After Eddie Merlot's and Jeff Ruby's, the other guys don't even taste like steak. And some of the presentations are so bad. I went to a horrible one for rivaroxaban a few months ago. I could have done better than the paid speaker. The best I've attended this year was for Prolia, a drug that's so ridiculously expensive that I've never dispensed, recommended or administered it. Sometimes I feel guilty going to these dinners when I do even like the drug (hello, Pradaxa), but I do like food so...

All4MyDaughter said:

Drug rep dinners have ruined me on steaks in regular restaurants. After Eddie Merlot's and Jeff Ruby's, the other guys don't even taste like steak. And some of the presentations are so bad. I went to a horrible one for rivaroxaban a few months ago. I could have done better than the paid speaker. The best I've attended this year was for Prolia, a drug that's so ridiculously expensive that I've never dispensed, recommended or administered it. Sometimes I feel guilty going to these dinners when I do even like the drug (hello, Pradaxa), but I do like food so...

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Who can pass up steak dinner? Medium rare, grilled asparagus on the side, and a fine glass of pinot noir?

rxlea said:

Who can pass up steak dinner? Medium rare, grilled asparagus on the side, and a fine glass of pinot noir?

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Last meal at Jeff Ruby's - crab fritters, filet (medium), asparagus, mashed potatoes and cheesecake. Oh and my favorite wine - Riesling. I like white wine better. Currently missing that daily indulgence.

All4MyDaughter said:

Last meal at Jeff Ruby's - crab fritters, filet (medium), asparagus, mashed potatoes and cheesecake. Oh and my favorite wine - Riesling. I like white wine better. Currently missing that daily indulgence.

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You'll have it soon! And you can have extra in true celebratory fashion. I'm so excited for you!

MmMm mmMmm. Crab fritters. Practically a sin.

rxlea said:

Who can pass up steak dinner? Medium rare, grilled asparagus on the side, and a fine glass of pinot noir?

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Sounds perfect with the exception of medium instead of medium rare...

One Touch is putting on some dinners for their new meter.

I've only gone to one at a local fish restaurant. The salmon was decent.

All4MyDaughter said:

Drug rep dinners have ruined me on steaks in regular restaurants. After Eddie Merlot's and Jeff Ruby's, the other guys don't even taste like steak. And some of the presentations are so bad. I went to a horrible one for rivaroxaban a few months ago. I could have done better than the paid speaker. The best I've attended this year was for Prolia, a drug that's so ridiculously expensive that I've never dispensed, recommended or administered it. Sometimes I feel guilty going to these dinners when I do even like the drug (hello, Pradaxa), but I do like food so...

Click to expand...

I'm going to a rivaroxaban dinner in a few weeks. I've actually done a few presentations on the drug, so hopefully it goes better than the one you saw.

Prolia is a pretty cool drug. Forteo and Reclast aren't exactly cheap drugs either, and those are the main competitors. I had a rotation in an endocrinology clinic and they administered all 3 fairly often.

KARM12 said:

Sounds perfect with the exception of medium instead of medium rare...

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Girlie man.

Teflaro seems to really be making the rounds at my hospital right now.

Edit: And their drug reps were definitely lookers.

Ackj said:

Prolia is a pretty cool drug. Forteo and Reclast aren't exactly cheap drugs either, and those are the main competitors. I had a rotation in an endocrinology clinic and they administered all 3 fairly often.

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The focus of the presentation was primary/ambulatory care related and the point was to sell Prolia as a convenient alternative to bisphosphonates. A tougher sell, considering the cost difference. It was still a very good presentation in terms of presenting the development of the drug and not overselling/lying about the evidence.

Reclast is the one I got a makeup bag for.

All4MyDaughter said:

Pristiq
Nuvigil
Solodyn
Moxatog

Clearly superior products...

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A little perspective from the PBM side....It's because generics don't work and cause, dry eye, nausea, vomitting, rash, hives, itching, convulsions, memory loss, leg twitching, twitching in general, stomach pain, eye balls burning out pain, global warming, finacial crissi in Europe, high gas prices and unemployment.

Instead of the doctor having a pair of balls and telling the patient they are full of crap. The doctor filsl out the brand penalty and tiering override forms and put this ridiculous crap on there.

MountainPharmD said:

A little perspective from the PBM side....It's because generics don't work and cause, dry eye, nausea, vomitting, rash, hives, itching, convulsions, memory loss, leg twitching, twitching in general, stomach pain, eye balls burning out pain, global warming, finacial crissi in Europe, high gas prices and unemployment.

Instead of the doctor having a pair of balls and telling the patient they are full of crap. The doctor filsl out the brand penalty and tiering override forms and put this ridiculous crap on there.

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Sometimes the physicians actually believe that crap!!

You guys should consider the compliance issues that arise with a patient who has been bombarded with advertisements for a drug and who lives in a society that believes expensive=better. Aside from not always knowing the cost of a drug off hand, sometimes prescribing something brand name can be worth it if it is a treatment the pt believes in.

pinipig523 said:

Correction - we have 2.

That said, I will concede pharmacological expertise to pharmacists like you and my wife, but unless you guys are sure about your diagnosis and mode of treatment AND are willing to be liable for your treatment (malpractice insurance), then I'm all for it. But I don't see this as an overall good thing for patients without continuity of care. Who's going to manage their long term cholesterol levels or blood pressure? Do you know the latest studies regarding ideal levels and have you had experience managing them over the long term?

Not to mention, if you work for a big corporation like Walgreens... They're just going to add this to your list of things to do without reimbursement on your part in addition to the added liability and headache. Like I'm sure many of you are jumping for joy when someone requests a flu shot or a lipid test.

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I think this is where you misunderstand. We are well aware that a pharmacists area of expertise is not in diagnostics. A pharamacists' training does not equip them to diagnose on the level of that of a physician. However, a pharmacist is well equipped to carry out a course of action using medication or therapy AFTER a diagnosis is given.

No one is trying to replace physicians. But I think the level of expertise that pharmacists carry is valuable and can be put to better use in regards to patient care.

hello sammi said:

I think this is where you misunderstand. We are well aware that a pharmacists area of expertise is not in diagnostics. A pharamacists' training does not equip them to diagnose on the level of that of a physician. However, a pharmacist is well equipped to carry out a course of action using medication or therapy AFTER a diagnosis is given.

No one is trying to replace physicians. But I think the level of expertise that pharmacists carry is valuable and can be put to better use in regards to patient care.

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You still don't get it. What I'm saying is that not everyone who comes in with a diagnosis but with an exacerbation may not be purely rectifiable by a refill of their current medicine.

pinipig523 said:

You still don't get it. What I'm saying is that not everyone who comes in with a diagnosis but with an exacerbation may not be purely rectifiable by a refill of their current medicine.

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Oh God, do you think pharmacists are THAT stupid to not recognize new problems arising from existing conditions? You clearly have this image of pharmacists as technicians that just handout pills and forget about the patient afterwards.

SpecterGT260 said:

You guys should consider the compliance issues that arise with a patient who has been bombarded with advertisements for a drug and who lives in a society that believes expensive=better. Aside from not always knowing the cost of a drug off hand, sometimes prescribing something brand name can be worth it if it is a treatment the pt believes in.

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We are more aware of compliance issues than the MD's are. I see your patient once a month and know exactly what they are and are not taking. You see them for 15 minutes once a year.

Does the patient run your practice or do you? What you describe above is exactly why I have a job with a PBM. Because MD's are big ******* and take the lazy way out instead of educating thier patients. I guess in that once a year 15 minute appointmnet there isn't time to practice medicince so you let me be the bad guy.

MountainPharmD said:

We are more aware of compliance issues than the MD's are. I see your patient once a month and know exactly what they are and are not taking. You see them for 15 minutes once a year.

Does the patient run your practice or do you? What you describe above is exactly why I have a job with a PBM. Because MD's are big ******* and take the lazy way out instead of educating thier patients. I guess in that once a year 15 minute appointmnet there isn't time to practice medicince so you let me be the bad guy.

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Wow. I didn't expect you to be this ignorant of MD practice. For what its worth, I've never had an interaction with a pharmacist more meaningful than I have with a Walmart checkout dude. But you don't see me trying to boil your practice down to that I would be highly surprised if you know anything about any of the patients medical history beyond Rx history. I really hope you are aware how silly and misinformed this statement is

notafraid87 said:

Oh God, do you think pharmacists are THAT stupid to not recognize new problems arising from existing conditions? You clearly have this image of pharmacists as technicians that just handout pills and forget about the patient afterwards.

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He is right in one thing....WHY ON EARTH would a pharmacist want more responsibility? Walgreens and CVS will NOT increase the salary period. If that is the case then I want LESS responsibiliity and work.

It would be a different story if pharmacist gets prescribing ability and start making 200K a year...but that's just not the case! If my paid is the SAME why do I want more work? I don't. No thanks!

SpecterGT260 said:

Wow. I didn't expect you to be this ignorant of MD practice. For what its worth, I've never had an interaction with a pharmacist more meaningful than I have with a Walmart checkout dude. But you don't see me trying to boil your practice down to that I would be highly surprised if you know anything about any of the patients medical history beyond Rx history. I really hope you are aware how silly and misinformed this statement is

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You are right in that sometimes prescribing brand name drugs is good IF and ONLY IF the drug company offers those discount cards that makes the copay like $25.

I grew up with NO insurance. My parents are self employed....I had to take solodyn once and my Derm gave me a card that made the drug cost only $25. If that's the case then I don't see a problem with brand name drugs.

However, Mountain is right in that doctors do NOT interact with patients much period. My Derm saw me once every 3 months. He looks at me for 5 minutes and gives me refills on my drugs and ask me about school and that's it. LOL...

I see my Derm for 15 minutes every 3 to 6 months and he doesn't know anything about me..he would NEVER know if I am taking my meds or what other meds I am on....he literally only look at me for 5 minutes and give me refills and that's it. So what Mountain is saying is 100% right.

SpecterGT260 said:

Wow. I didn't expect you to be this ignorant of MD practice. For what its worth, I've never had an interaction with a pharmacist more meaningful than I have with a Walmart checkout dude. But you don't see me trying to boil your practice down to that I would be highly surprised if you know anything about any of the patients medical history beyond Rx history. I really hope you are aware how silly and misinformed this statement is

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Mountain is correct. Prescribing brand name drugs "to increase compliance" is silly. It also increases health care costs because the vast majority of patients are not self-pay. Sure, your patient may feel good about that brand name script for Edarbi (or whatever), but when the copay card runs out, and they find out that they are on the hook for $50 copay, you'll be getting a call from the pharmacist to switch. Or you may just get that call sooner when your brand name scripts require a PA. That's where Mountain comes into the game. He'll be the one denying your PA request because "brand name drugs increase compliance" doesn't really meet the standard of medical necessity.

SHC1984 said:

He is right in one thing....WHY ON EARTH would a pharmacist want more responsibility? Walgreens and CVS will NOT increase the salary period. If that is the case then I want LESS responsibiliity and work.

It would be a different story if pharmacist gets prescribing ability and start making 200K a year...but that's just not the case! If my paid is the SAME why do I want more work? I don't. No thanks!



You are right in that sometimes prescribing brand name drugs is good IF and ONLY IF the drug company offers those discount cards that makes the copay like $25.

I grew up with NO insurance. My parents are self employed....I had to take solodyn once and my Derm gave me a card that made the drug cost only $25. If that's the case then I don't see a problem with brand name drugs.

However, Mountain is right in that doctors do NOT interact with patients much period. My Derm saw me once every 3 months. He looks at me for 5 minutes and gives me refills on my drugs and ask me about school and that's it. LOL...

I see my Derm for 15 minutes every 3 to 6 months and he doesn't know anything about me..he would NEVER know if I am taking my meds or what other meds I am on....he literally only look at me for 5 minutes and give me refills and that's it. So what Mountain is saying is 100% right.

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I gotta be honest with you - I would love for drug advertisements to simply go away and for readily available generics for everything. "Generic OK" will likely become part of my signature

However mountain is dead wrong. Sure, some docs do not do much interaction. I could see it being more common in things like derm or OB/gyn for otherwise healthy individuals. I can also tell you that neither my pharmacist NOR my doctor have any idea if I am taking any meds that I have been prescribed. Statements like the one made by mountain are incredibly ignorant of the practice of primary and chronic care (hell.... maybe all of the docs they make us follow around are putting their best foot forward while the med student is in the room but I get the feeling they don't give a rat's ass if I am there or not). In the overall world of pharmacy, I do not think it is fair to claim that the pharmacist knows more about the patient in terms of medical history and need than the doctor does. To claim that doctors just humor the patient for 15 minutes once a year would be offensive if not for the irony of the pharmacist whose breadth of interaction is filling a bottle once a month I am not trying to bash your guys jobs at all, but please don't be so cut and dried about us either. Only routine checkups are once a year and I cant think of many chronic conditions that the doc doesnt want to see you for a full workup every 3-6 months. On top of that - the rest of the team will put the patient through whatever tests are ordered so even if there is only 15 minutes of face time, this should not be interpreted as 15 minutes of exposure to the patient. That is just wrong.

All4MyDaughter said:

Mountain is correct. Prescribing brand name drugs "to increase compliance" is silly. It also increases health care costs because the vast majority of patients are not self-pay. Sure, your patient may feel good about that brand name script for Edarbi (or whatever), but when the copay card runs out, and they find out that they are on the hook for $50 copay, you'll be getting a call from the pharmacist to switch. Or you may just get that call sooner when your brand name scripts require a PA. That's where Mountain comes into the game. He'll be the one denying your PA request because "brand name drugs increase compliance" doesn't really meet the standard of medical necessity.

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I wasnt defending prescription of brand name drugs. I was stating it as an unfortunate fact of the clinic. Patients want the fancy drug and it can be difficult to convince them otherwise. I am all for generics. I agree that compliance isnt a good reason. In an ideal world the patient would simply trust all levels of the healthcare team and we wouldnt have to play games with the patient's worldview in order to affect treatment. The major issue I took with mountains post was that as a doctor we will only see our patients for 15 minutes once a year. That is wrong. Sure, maybe your dermatologist just looks you over and gives you a skin cream. Sure maybe your radiologist doesnt send you a christmas card. This is still a gross oversimplification and just a poor argument in general. I don't know if you guys have really experienced a patient who didnt get exactly what they thought they needed so they assume the doctor is uncaring or uninvested or whatever. it is a "damned if you do damned if you dont" situation. You can try to explain to the patient why another drug will be just as good, but risk the patient feeling like you think they are dumb or whatever other myriad of interpretations can come of it. If you think my original post was to say "educating patients is a waste of time" then you misunderstood me.

SpecterGT260 said:

I gotta be honest with you - I would love for drug advertisements to simply go away and for readily available generics for everything. "Generic OK" will likely become part of my signature

However mountain is dead wrong. Sure, some docs do not do much interaction. I could see it being more common in things like derm or OB/gyn for otherwise healthy individuals. I can also tell you that neither my pharmacist NOR my doctor have any idea if I am taking any meds that I have been prescribed. Statements like the one made by mountain are incredibly ignorant of the practice of primary and chronic care (hell.... maybe all of the docs they make us follow around are putting their best foot forward while the med student is in the room but I get the feeling they don't give a rat's ass if I am there or not). In the overall world of pharmacy, I do not think it is fair to claim that the pharmacist knows more about the patient in terms of medical history and need than the doctor does. To claim that doctors just humor the patient for 15 minutes once a year would be offensive if not for the irony of the pharmacist whose breadth of interaction is filling a bottle once a month I am not trying to bash your guys jobs at all, but please don't be so cut and dried about us either. Only routine checkups are once a year and I cant think of many chronic conditions that the doc doesnt want to see you for a full workup every 3-6 months. On top of that - the rest of the team will put the patient through whatever tests are ordered so even if there is only 15 minutes of face time, this should not be interpreted as 15 minutes of exposure to the patient. That is just wrong.

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I have several chronic conditions. I've been on both sides of the issue. I can tell you that Mountain is right. I am not seen every 3-6 months. I'm seen once a year and get all my scripts renewed. It IS that cut and dry in the real world. Someone's been drinking the kool-aid.

cycloketocaine said:

I have several chronic conditions. I've been on both sides of the issue. I can tell you that Mountain is right. I am not seen every 3-6 months. I'm seen once a year and get all my scripts renewed. It IS that cut and dry in the real world. Someone's been drinking the kool-aid.

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does your PCP defer to you at all because of your profession? I'm not treating patients myself, obviously, but I have seen enough patient charts in our IM outpatient or FM clinics to know that he is wrong I didnt say it cannot happen, but anecdote is a terrible premise upon which to build a rule. If that really is the case for you, and you feel it is a problem, find a new PCP.... but I suspect this arrangement works just fine for you given your training. Do you expect us to water board you until you divulge additional information about your personal life and experiences?

SpecterGT260 said:

I gotta be honest with you - I would love for drug advertisements to simply go away and for readily available generics for everything. "Generic OK" will likely become part of my signature

However mountain is dead wrong. Sure, some docs do not do much interaction. I could see it being more common in things like derm or OB/gyn for otherwise healthy individuals. I can also tell you that neither my pharmacist NOR my doctor have any idea if I am taking any meds that I have been prescribed. Statements like the one made by mountain are incredibly ignorant of the practice of primary and chronic care (hell.... maybe all of the docs they make us follow around are putting their best foot forward while the med student is in the room but I get the feeling they don't give a rat's ass if I am there or not). In the overall world of pharmacy, I do not think it is fair to claim that the pharmacist knows more about the patient in terms of medical history and need than the doctor does. To claim that doctors just humor the patient for 15 minutes once a year would be offensive if not for the irony of the pharmacist whose breadth of interaction is filling a bottle once a month I am not trying to bash your guys jobs at all, but please don't be so cut and dried about us either. Only routine checkups are once a year and I cant think of many chronic conditions that the doc doesnt want to see you for a full workup every 3-6 months. On top of that - the rest of the team will put the patient through whatever tests are ordered so even if there is only 15 minutes of face time, this should not be interpreted as 15 minutes of exposure to the patient. That is just wrong.

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Fair enough. I do not have any chronic diseases...my only experience with doctors are with my Derm.

I guess what Mountain mean is as a pharmacist I can tell what ALL the drugs the patient is taking by looking at their drug list. I can see if they are compliant or not by looking at the fill dates...if a patient hasn't been picking up his or her meds then I know he must not be taking it as directed.

A doctor will never be able to tell if a patient has been picking up his or her meds, they will not know all the meds the patient is on b/c they have no access to the list of drugs the patient have gotten filled.

A pharmacist can easily look at all the fill dates and tell if the patient has been taking the drug once a day or not.

SHC1984 said:

Fair enough. I do not have any chronic diseases...my only experience with doctors are with my Derm.

I guess what Mountain mean is as a pharmacist I can tell what ALL the drugs the patient is taking by looking at their drug list. I can see if they are compliant or not by looking at the fill dates...if a patient hasn't been picking up his or her meds then I know he must not be taking it as directed.

A doctor will never be able to tell if a patient has been picking up his or her meds, they will not know all the meds the patient is on b/c they have no access to the list of drugs the patient have gotten filled.

A pharmacist can easily look at all the fill dates and tell if the patient has been taking the drug once a day or not.

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I would agree with this and stated this exact benefit earlier in the thread.

It isnt uncommon for a patient to sheepishly admit that they have not been keeping up on their meds. Ive seen it a few times and the doc I'm following is put in a hard spot. How do you fix it? I myself have even been guilty of stopping a treatment because I didn't the doctor gave me what I wanted - I am not pretending to be blameless in that scenario.

My whole point on this "doctors prescribing the expensive stuff" is that there are many components to it from not having the price sheet right in front of us to dealing with a patient who has wholly bought into the flashy commercial is magical TV talky box spit out at him the night before From what I have observed, in the clinic it comes down to some averaging of these issues in an attempt to get the patient to follow through with treatment. So if you guys come up with a parallel treatment plan that saves money and you wanna call up -by all means. I would very highly critical of any doc who gave you crap for that and it strikes me as old and out-dated competition which serves no purpose (but is still around ) but that doesnt mean that the simple act of prescribing a name-brand makes us "lazy [whatever was in those stars]"

Hmm....if a patient ONLY wants brand name drugs and listens to adverstiments all the time then I would imagine he or she would not mind paying for it. You can't want the best and not want to fork over the price for it!

I mean if you want only brand name drugs and refuse to take anything else then it would be very odd of you to get upset at the prices that you have to pay for it.

I mean I use to use Tazorac when I was younger...I know it's expensive but I wanted it anyways so I had no problem paying for it. It was quite expensive, but that's what I want.

A patient should know their choices...you can go brand name and pay more money or if you want the cheap way out then go generic.

The doctor should be "You want brand, it's going to cost you more...if you want generic it will be cheaper for you. What do you prefer?"

SpecterGT260 said:

does your PCP defer to you at all because of your profession? I'm not treating patients myself, obviously, but I have seen enough patient charts in our IM outpatient or FM clinics to know that he is wrong I didnt say it cannot happen, but anecdote is a terrible premise upon which to build a rule. If that really is the case for you, and you feel it is a problem, find a new PCP.... but I suspect this arrangement works just fine for you given your training. Do you expect us to water board you until you divulge additional information about your personal life and experiences?

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What you are experiencing in IM/FM outpatient clinics in a teaching institution cannot be generalized to private practice. The presence of medical students alone makes it a different type of environment. You talked about the physician spending a short amount of time with the patient but "the team" getting in more time with the patient. In most primary care private practice offices, "the team" is high school diploma medical assistants, secretaries and maybe a trained phlebotomist. They are hardly a substitute for more time with the physician.

You also said that you aren't treating patients yourself. That is very correct, and I would suggest that you'll come to see things differently when you are actually in charge. You aren't practicing medicine yet so your knowledge is limited. But I am actually practicing pharmacy, and I can promise you that I see the results of hurried primacy care visits and poor prescribing practices every single shift I work. And because I do WAY more than "fill a bottle once a month" (thanks for the insulting generalization, by the way) I notice and rectify things like:

-Patient on two basal insulins who was having night sweats and palpitations from low blood sugar
-Patient discharged from the hospital on three SSRI's because the discharging MD just signed off on the med rec without looking at it
-Patient with DM on a medication no longer recommended for patients with DM because of increased cardiovascular risk - the patient hadn't seen his doctor in 9 months and had two more months of refills left, until I intervened and got him switched to something else
-Patient with incorrectly prescribed NPH insulin and ineffective sliding scale bolus insulin who was experiencing extremely high blood sugars and syncope

And so on.

I don't minimize the pressure on physicians, especially in private practice. They have to see volumes of patients to keep the doors open. I get that, and I'm sympathetic. So you shouldn't minimize the role of pharmacists, because one day, one of us may just help one of your patients.

SpecterGT260 said:

I would very highly critical of any doc who gave you crap for that and it strikes me as old and out-dated competition which serves no purpose (but is still around ) but that doesnt mean that the simple act of prescribing a name-brand makes us "lazy [whatever was in those stars]"

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Well, you have LOTS of colleagues out there who you should be "very highly critical of." You haven't practiced medicine yet and like I said, your teaching clinic experiences are NOT representative of the private practice world.

Also, if you are going to be all hurt by Mountain's posting style, you may just want to ignore his posts. He is the way he is, and he's blunt and sometimes even rude, but he's a health care professional with years of experience and highly respected on this forum. No point in getting your knickers in a twist over some stars.

All4MyDaughter said:

Well, you have LOTS of colleagues out there who you should be "very highly critical of." You haven't practiced medicine yet and like I said, your teaching clinic experiences are NOT representative of the private practice world.

Also, if you are going to be all hurt by Mountain's posting style, you may just want to ignore his posts. He is the way he is, and he's blunt and sometimes even rude, but he's a health care professional with years of experience and highly respected on this forum. No point in getting your knickers in a twist over some stars.

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With all due respect, you and I have both practiced medicine to an equal degree. Practicing a parallel role doesn't lend insight into that practice. So much of what is being said here indicates you all believe that physicians don't know what pharmacy entails. This goes both ways

And it is also my posting style . I'm not upset by him. Are we not allowed to butt heads?

SpecterGT260 said:

With all due respect, you and I have both practiced medicine to an equal degree. Practicing a parallel role doesn't lend insight into that practice.

And it is also my posting style . I'm not upset by him. Are we not allowed to butt heads?

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I trained in teaching institutions just like you did. Rounded with "the team" and worked in outpatient primary care clinics during rotations, just like you. I'm now out in practice and know that the teaching institution experience is pretty dissimilar to actual private practice in non-academic settings. Do you disagree?

All4MyDaughter said:

I trained in teaching institutions just like you did. Rounded with "the team" and worked in outpatient primary care clinics during rotations, just like you. I'm now out in practice and know that the teaching institution experience is pretty dissimilar to actual private practice in non-academic settings. Do you disagree?

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I cannot comment on private practice aside from my limited exposure (father is a private practice doc and I make no claim that n=1 makes a rule). however I did edit my post which didnt make it into your response. Do you not agree with this?

So much of what is being said here indicates you all believe that physicians don't know what pharmacy entails. This goes both ways

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rxlea said:

I made that comment for emphasis. Drug companies do spend billions of dollars marketing their product. Drug reps are a part of that. I've never, ever seen an unattractive rep, btw. Have you? It's kind of the ongoing joke that they are good looking.

To your point, several institutions have begun to prohibit gifts, lunches, etc. That was not always the case, however. There are still plenty of institutions, PCPs, and others who accept gifts like t-shirts, pens, notepads. Once we were given makeup bags lol Our company has since prohibited any gifts but only in the last few years or so.

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http://www.google.com/search?hl=en&....,cf.osb&fp=f0ede0cbac5ee01d&biw=1280&bih=709

Case and point

hereticmnk said:

http://www.google.com/search?hl=en&....,cf.osb&fp=f0ede0cbac5ee01d&biw=1280&bih=709

Case and point

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Really???







Why is everyone so eager to a doctor's job? Is your job description that boring? Then why didn't you go to med school?????????

SpecterGT260 said:

I cannot comment on private practice aside from my limited exposure (father is a private practice doc and I make no claim that n=1 makes a rule). however I did edit my post which didnt make it into your response. Do you not agree with this?

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Yes, I just saw your edit. I'm not sitting here reloading the screen obsessively looking for changes to posts.

Sure, we pharmacists don't fully understand what's involved in the practice of medicine. Although, I did just spend a year working (as part of my residency) one day per week in a primary care office (non-teaching institution) as part of a pilot project. So I may have a little more insight than you're giving me credit for.

But I definitely think that someone who would spout crap like...

SpecterGT260 said:

the pharmacist whose breadth of interaction is filling a bottle once a month

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and

SpecterGT260 said:

For what its worth, I've never had an interaction with a pharmacist more meaningful than I have with a Walmart checkout dude.

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... probably doesn't understand what pharmacy entails and clearly doesn't have much respect for pharmacy.

notafraid87 said:

Oh God, do you think pharmacists are THAT stupid to not recognize new problems arising from existing conditions? You clearly have this image of pharmacists as technicians that just handout pills and forget about the patient afterwards.

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No I do not - my wife and brother are pharmacists and I have interacted with many over the years (clinical ones as well).

I know that you don't get to see the vitals for the patient, I know you don't have a nurse triaging the patient. I know you don't get the full story on the patient.

Why? Because you guys in retail are busy (rightfully so) running around like your heads are cut off while WAGS cuts down your tech coverage and pharmacist coverage. There's no way you can adequately assess a patient for a "refill" given all the constraints you work in.

And - you're not trained for it.

pinipig523 said:

No I do not - my wife and brother are pharmacists and I have interacted with many over the years (clinical ones as well).

I know that you don't get to see the vitals for the patient, I know you don't have a nurse triaging the patient. I know you don't get the full story on the patient.

Why? Because you guys in retail are busy (rightfully so) running around like your heads are cut off while WAGS cuts down your tech coverage and pharmacist coverage. There's no way you can adequately assess a patient for a "refill" given all the constraints you work in.

And - you're not trained for it.

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1. Not all community pharmacists work under the conditions you describe. I don't, and none of my colleagues do.
2. We are at least as qualified to assess a patient for a one-time refill on a maintenance med than the secretary who answers the phone at the doctor's office and says, "yeah, it's fine," without asking the doctor. Happens all the time.

All4MyDaughter said:

1. Not all community pharmacists work under the conditions you describe. I don't, and none of my colleagues do.
2. We are at least as qualified to assess a patient for a one-time refill on a maintenance med than the secretary who answers the phone at the doctor's office and says, "yeah, it's fine," without asking the doctor. Happens all the time.

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1. I will agree with you there, but you will agree with me when I say the majority work as I described.
2. Just because it's been done - doesn't mean it's right. I can't tell you how many "bounce backs" I've had in the ER from this practice from PCP. It's not right and there should be a way to stop it. And because it's not right, I will not agree that it is right for a pharmacist to do the same either.

Just this past week -

I had a patient who came in near sepsis after the PCP's front people ok'd a prescription for an antibiotic for the wrong amount of days and led to incomplete treatment for a UTI and now the patient was having pyelo.

pinipig523 said:

1. I will agree with you there, but you will agree with me when I say the majority work as I described.
2. Just because it's been done - doesn't mean it's right. I can't tell you how many "bounce backs" I've had in the ER from this practice from PCP. It's not right and there should be a way to stop it. And because it's not right, I will not agree that it is right for a pharmacist to do the same either.

Just this past week -

I had a patient who came in near sepsis after the PCP's front people ok'd a prescription for an antibiotic for the wrong amount of days and led to incomplete treatment for a UTI and now the patient was having pyelo.

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So what's the solution? Is it better to continue status quo, where unqualified people with high school diplomas who happen to have a job answering phones in a doctor's office make medical decisions, or is it better to have a health care professional screen the patient and decide on the refill? It's problematic if the pharmacist isn't properly trained and doesn't have the time to do a thorough screen built into his or her workflow, but I'm still not sure that it's WORSE than what we currently have, which is secretaries saying "yes, whatever" to any and every request.

pinipig523 said:

1. I will agree with you there, but you will agree with me when I say the majority work as I described.
2. Just because it's been done - doesn't mean it's right. I can't tell you how many "bounce backs" I've had in the ER from this practice from PCP. It's not right and there should be a way to stop it. And because it's not right, I will not agree that it is right for a pharmacist to do the same either.

Just this past week -

I had a patient who came in near sepsis after the PCP's front people ok'd a prescription for an antibiotic for the wrong amount of days and led to incomplete treatment for a UTI and now the patient was having pyelo.

Click to expand...

You have to admit this failure in communication between providers happens in all of medicine and would not be limited to rphs if they got in on the game. If I had a dollar for every time I heard a case presentation (by physicians, not rphs/students/whatever) where we had drugs on board without an indication from an outside dr, I'd be going to the caymans this year.

So, this is why you guys are so eager to do a physician's job:

http://singularityhub.com/2011/04/1...uman-pill-counting-talents-go-to-waste-video/