Office visits are slowly becoming the latter. Like this story of a patient who “demanded” an antibiotic for her $50 co-pay:
After giving the situation a few minutes to cool off, I went back into the room and offered her a compromise. I would give her the antibiotic prescription if she agreed not to fill it unless her symptoms worsened or didn’t improve after a week. She quickly and very gratefully accepted.To me, the irony was painful. Practicing good medicine would make her hate me, but providing good customer service made her thank me as if I’d just saved her life.
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{ 6 comments }
Congratulations on learning the art of medicine.
My duty is to my patient, not to society. I don’t care if I contribute to microbial resistance by prescribing unnecessary antibiotics. Sorry, society. When we have a test that conclusively rules out bacterial infection, then I might reconsider.
I inform the patient that they have a viral illness (or UTI symptoms without infection) that antibiotics won’t help. I tell them that they are more likely to have side effects from the antibiotic than they will benefit from such treatment. If they still want antibiotics anyway, I will try to choose one that is cheap, old-fashioned, and unlikely to cause them harm, then document their wishes and my explanation.
Which is why these such antibiotics may as well be available over the counter for $4.00 at Walmart.
When Zantac was prescription only, patients would beg me for it. Now, they want Nexium or Protonix instead of even Prilosec.
When Motrin was prescription only, it was a wonder drug. Now patients think it’s as worthless as candy.
They always want what is hard to get, even if it doesn’t work any better than what they can get themselves.
Scaple, thats a good point but also is the fact that our Doc’s tell us that these NEW drugs work much better than the older, easily available ones.
I have tried to get my Doc to allow me OTC Prilosec and/or tagamet. His answer is “NOPE, nexium works better and that’s what I want you on.” So, this is not always the patients fault when this happens.
It is interesting, but invariably when a new drug comes to market, it always seems to have some advantage for the company to tout versus existing drugs. It may be tolerability or dosing convenience; it is not necessarily efficacy.
I think generics by and large will predominate and be good enough for the population at large, especially where federal dollars are concerned. Remember that many a new drug is just a twist of a molecule here, a double bond there to get a new patent. Sometimes real differences do exist, but the rest is marketing.
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