Yes! Hate Mail!

Wrong on many counts.
1. Family docs are well aware of the costs of the meds. We know which ones
are covered by the government for seniors, which ones require a limited use
code for coverage and which ones don’t have a generic equivalent. The
pharmacists don’t do that for us. If we don’t get it right we get a fax
from the pharmacy refusing the script.

Are you sure? Why do I see at least three times a day a doctor prescribing Levaquin to a known private pay patient. You know, the types that get pissed off because now they have to wait to get it changed because a 10 day run costs over 100 bucks. Yet when I ask “did you tell the doctor you didnt have Rx insurance” the response is “I sure did, he said it costs ‘about 30 dollars or so'”.
How about the rare times doctors themselves actually call in Rx’s, and say “oh shit” when I say “are you sure you want to prescribe that? Mrs Jones has no Rx coverage, and thats over 200 dollars”.
I call bullshit on your statement. You may know the cost of the medications, but ‘family doctors’ have little to know clue as to how much Crestor or Levaquin or Lipitor costs. Unless I somehow work in town full of retarded doctors (which I seriously doubt).

2. Docs get nothing from drug reps for prescribing their products. They’re
not allowed to leave anything more than free samples, so no one is getting
lap dances out here.

Riiiiiiiiiiiiight. You must live in a state that has those ‘free good’ laws out there. We have a clinic next door, and they look like santa waltzing in with bags and bags of free shit. They have paperweights, coupons, notepads, pens, etc, etc, etc. They come with their dinners and golf trips and vacations and on and on and on.

3. Some newer drugs have evidence behind them (meaning large-scale RCT’s)
proving that they work better. And some patients have had side effects or
poor response to the older ones. So not every doc prescribing the new med
over the old one is doing so with no therapeutic intent.

Did you read the studies? Or just listening to the reps who push them. The devil is in the details, and I bet if you actually sat down and read that clinical study (rather than just listening to a talking head), you’d actually realize that the glamor and hype whats news is just a rehash of something old and generic and cheap. Remember the first rule of Journal reading: See who paid for the study.

Rant away, angry one. But maybe you’ll want to step out behind the counter
every now and then and get back in touch with reality.

Dont have enough time too. Im too busy listening to your patients complain about their cost of their medications, answering questions about their health because ‘the doctor was too busy to answer this for me’, and giving explanations/excuses on why your office hasn’t faxed back my refill request/med change in 2 days.
Oh, you’re a Canadian ER Doctor (from what it looks like on your blog, i spent 2 min’s looking at it, so I might of missed something huge). Lets see how this changes things:

  • Different laws in Canada with regard to drug reps
  • Different pricing scheme (regulated by the government, not free market) so of course you know the prices of everything.
  • You’re an ER doctor. I hope you have a private practice somewhere.
    I’m at a loss to understand why you are bitching about an American Pharmacist ranting about an American Senior Drug Program and American Doctors.

  • Medicare Part D – The Donut Hole, Your Doctor, and You

    I’m not dead! I swear! I just have been busy with work and not drinking myself into a coma.
    The Donut Hole.
    Those three magic words that all Medicare Part D patients hope they never hear. The gap in coverage where you must pay out of your own pocket for your medications.
    I hold Doctors partially to blame for the shit we have to go through when patients hit their donut hole. Before you give me hate-mail-o-rama, lets elaborate:
    You have a patient who is on Medicare Part D. Suddenly, all of these new and spiffy trade-name medications are only $3.10! So what does the doctor do? He starts writing for that ARB when a generic ACE-I is okay. He starts writing for Lipitor when the patient has been on generic Zocor for months. He starts getting blowjobs and lapdances from the drug reps in return for prescribing Levaquin when generic Cipro would be okay. “Hell! Its only $3.10! Why not! The patient only pays $1 for generics, whats another $2.10 for a drug that works ‘better’!!!”.
    In reality, the doctor is screwing over the patient, big time. In fact, he’s screwing over the patient more than anyone else could. You see, all of those big expensive trade name medications are going on a tab. A tab that pushes the patient further and further towards the donut hole. So their $2400 allotment of ‘coverage’ is now burnt up in 3 months because Mr “Its only $3.10” Doctor switched them all over to trade name medications. How many doctors realize this? About 10. How many doctors care? Zero.. “Its the pharmacists responsibility to take care of this, even though I’ll deny any generic request he submits!”
    So who’s sitting there with their puds in their hands. Isnt the doctor, he gets his kick..er..incentives from the drug companies regardless. Its the patient and the pharmacist. The patient because he now has to pay out of pocket for $2,000 or so dollars until he hits “catastrophic coverage”; and the pharmacist because WE have to explain all of this shit to the patient and hear their whining.
    Sure we can switch them all back to generics, but its a catch-22. If you switch them all to generics they’ll be in the donut hole longer (because their total cost of drugs per month decreased due to generic switch). If you keep on the expensive trade name medications, they’ll be out of the donut hole quicker, but will pay more per month. Wonderful isn’t it?
    In the defense of doctors, they really have no clue how much stuff costs now days. If you’re a doctor, and reading this, the cost of the drug is directly proportional to how many annoying drug reps come and visit you. Why would a drug that cost pennies be pushed so hard by men in suits and women in short tops? Think about it.

    Showers. They are your friend!

    Close your eyes and imagine this.
    Take some cat piss, add a large pinch of BO and put a good helping of stale stank on top of that. Now coat a woman in it and have her walk right into your store and stand in front of your counter. I knew something was very seriously wrong when my clerks politely walked back past me into the break room.
    I almost threw up. My tech almost threw up. The fly on the wall almost threw up. Dogs came far and wide to roll on this woman. Rolling in a pile of musty cat shit would of been an improvement.
    Now the hard part, to drop the hint that you smell like moldy-death-ass without being insulting. Lets examine our options. Mind you that we have done ALL of these over the years to patients:

  • Spraying air freshener in the air back in the pharmacy: Not insulting
  • Spraying air freshener on the woman herself: Mildly Insulting
  • Turning all the fans on in the pharmacy: Not Insulting
  • Slamming the can of air freshener on the counter in front of the woman: Insulting
  • Opening the doors to the pharmacy to air it out: Not Insulting
  • Opening the doors to the pharmacy to air it out during the middle of winter when its 40F outside: Can be insulting
  • Having all the clerks run to the back and refuse to help her: Insulting
  • Having the entire pharmacy staff run to the back and refuse to help her: Very Insulting
  • Having the clerk get dry heaves in front of her: Mildly Insulting
    Is there a polite way to say “Hey! Take a Bath”? Once a man came into the pharmacy (smelling of death) complaining of sores all over his body. The pharmacist told him to fill the bathtub full of water thats about 100F, and sit in it for 10 mins. He came back later to say how well it worked. Go figure.