Friday, July 23, 2010

Drug Reps in the Waiting Room.

Sarebear has been commenting on our posts for years now, since the very beginning of Shrink Rap. She sent us a link to one of her blog posts on Pie-Bolar Served w/ 3 Flavors of Anksia Tea and the post was a detailed discussion about her session that day with her psychiatrist. Lots of details and lots of sadness and angst, but a wonderful glimpse in to what happens in a session with a psychiatrist. I especially loved that Sarebear started her account in the waiting room where she sat with her family...the psychiatrist was running late and two drug reps were sitting there talking! What does a patient think about when such things intrude on their care? With permission, here's Sarebear's thoughts on Drug Reps in the Waiting Room:

My psychiatrist was twenty minutes late today, which means that she got in to the office at 9:20, which was when she was supposed to see ME, but her FIRST appointment, her 9:00, was still waiting to be seen, so I had to wait longer. UGH!! She said, "I'm sorry I'm so late!!", and the other patient said, "Don't worry about it", but I said absolutely nothing . . . . . lol. Can you tell I was a little peeved? In early morning traffic, it takes about 35 minutes to get there, so we had gotten up early, and had gotten there 10 minutes early, even, not wanting to shave it right to the minute. I suppose everyone has an off day, though. It's still annoying for me, as the patient! Guess I wasn't very "patient", heh. While I waited, just after the first patient went in, a pair of drug reps, one in training, came in, and dropped off some samples in her back room, then sat down to wait. I vowed that I'd get seen before them, because patients are more important. They talked alot of business, and about where each of them had worked, and some of the details of the software they were using on the laptop, that they wish they'd had at the previous place, and stuff. It was interesting to listen to them talk. Drug reps are a sadly necessary "evil" of the medical practice, because they provide drug samples for the doctors, without which you wouldn't be able to start some of the initial doses of certain medications, and sometimes the samples are used to help some patients afford the medications, although they do NOT replace the pharmacy, not at ALL. The drug reps also provide coupons and promotions for the patients to redeem for free two week or one month supplies of the medication, with prescription, at the pharmacy, whenever their companies are offering such coupons and promotions, so again, these things are good for the patient's pocketbook, their bottom line, for being able to afford the medications, when the insurance situation isn't ideal. Obviously some of these don't last very long, while other programs will, say, take half off the cost of the medication for a year, but whatever can help the patient, is a GOOD thing. It's just, the whole salesman aspect of the thing, seems a little . . . smarmy. It also feels a bit intrusive, to have salesmen in the medical setting like that, but as I say, it is a necessary "evil", even if one wonders about the influence that they may have over a doctor's prescribing practices. The most ethical doctors will not be influenced, but no one is perfect. Anyway, sitting there for awhile, listening to them, I didn't think they worked for Pfizer, the makers of Geodon, the medication I had been reduced in dose after my recent bad experience on, and was here today to be likely removed off of and put on possibly something else, but if they did, I wanted to tell them I thought it sucked. So, I asked them eventually, "Do you work for Pfizer?" They said, "No", so I continued anyway, since they'd still have an interest, and they did, and I said, "Well, Geodon sucks". They said, "We think so too, we sell a competing product." I said "Oh, okay. I hate it, because I had unexpected side effects." They then expressed their regrets to me that I'd had a hard time, and again said that they didn't like the med. I thought the whole interaction was a little bit funny, hee. Normally I wouldn't, as a patient, have any kind of interaction with drug reps at all, but since my psychiatrist was late, and since they'd been chatting for awhile so freely in front of my husband, daughter and I in the waiting room (after all, this is the type of location that is basically their workspace for the whole day; that, and their car, so one can't expect them to just sit there silently), so their chatting had encouraged me to eventually strike up a conversation, since there was nothing else to do while I waited for the doctor. When she eventually came out, as she walked past them to the front desk, she asked them if she needed to sign something, (I assume as in, to sign for the samples they'd dropped off in her back room) and they stood up and handed her a clipboard and started talking with her, the one in training did. I wondered if he'd bring up with her anything about the competing product for Geodon, since he knew she'd be bringing me off of that one, and potentially on something else, but it seems they had enough discretion NOT to go there, which amazed me slightly, for salesmen. They just brought up the coupons and promotions that are so helpful for patients, and got the signed clipboard back, and in the middle of signing it, she called me in to the office, which helped let the drug reps know that she'd not be spending a lot of time with them, and made me feel like I was her priority. I didn't feel badly that she'd signed for the samples, because otherwise these men would just be sitting around for another 25 minutes doing nothing, when just 2 minutes of her time took care of the whole matter.


Anonymous said...

Back in the day when physicians managed their own time, my dad was a GP. He decided early on that he would not allow drug reps to get in the way of patient time so he came up with an alternative. About every 6 weeks or so he scheduled a "detail day". The morning was blocked off to see drug reps on a first come basis. While waiting, they all got to talk shop and enjoy coffee and pasteries in the waiting room. Each got an equal amount of 1:1 time with the doc and all of them knew they had to do a quick standout presentation followed by his questions. As each one had their time with him they left. They loved it because it was an easy day and all of their bosses knew this was the only way to gain access to him. He got lots of samples and cool stuff like a model of the heart or the eye that we kids could play with. He spent the rest of the day catching up on paperwork and seeing the patients with emergent needs. Best of all, his patient never had to wait for a drug rep drop in.

Anonymous said...

This week I was waiting to see my psychiatrist. He was running a few minutes late, which has never happened before. A drug rep came in and asked to see the doc and the receptionist said he'd be right out. When the doc did come out, he called me straight back, and when I left the drug rep was gone, whether because someone else met with him or he didn't wait, I don't know.

If the doc had met with the rep instead of me, at my scheduled time, I would have walked out. I appreciated being seen as the valuable client/patient I am.

Sarebear said...

It later occurred to me that it probably wasn't legal for them to tell me what their competing product WAS, and that there is probably pretty strict rules about what they can and can't say directly to patients about products, ie, the drug companies can't directly market to patients except through print, radio, and tv ads. They were careful to never name what it is there product was, but to emphasize their dislike of the product competing with theirs that I, myself, had brought up, which seems like it would be an allowed thing for them to do, since I had brought it up.

It didn't occur to me until later to even think about the strict rules they probably operate under.

I didn't mind that she had quickly dealt with them while calling me back because I've personally benefitted from the savings coupongs and promotional cards myself before, as well as the samples. As well as the fact that she dealt with them so quickly. If she hadn't, I'd have been displeased, but everything was handled with professionalism and dispatch.

Sunny CA said...

My endocrinologist almost always has drug reps hanging around in the waiting room. I often have to wait an hour or more for him and he does take drug reps before patients. He also writes "no substitutions allowed" on his prescription for name brand l-thyroxine. I paid the $35 a month (insurance subsidized) for a long time before a conversation with my pharmacist informed that I can override the doctor and get generic which I do now at only $5 a month. The same doc is always trying to get me to take name brand metformin hydochloride, which I have refused, even though I have normal blood sugar because he says it will help me lose weight. He says one of his patients lost over 100 pounds taking metformin. Then I read a study online that said average weight loss is less than 10 pounds. It makes me feels he is in bed with the drug companies and this makes me distrust his drug recommendations.

Sarebear said...

Wow, Sunny, I'd really be dubious about the influence the drug reps have over that endocrinologist, too. Sounds fishy to me as well! Some docs have higher ethics than others.

Also, I feel honored to basically have a "guest post" of sorts on the Shrink Rap blog! Thanks, Dinah, it's very cool, and nice to be acknowledged as a commenter from the very beginning!

Dinah said...

Thank you for being our guest poster.

Sunny CA,
One of my patients lost 35 pounds when she started metformin. We sometimes get influenced by the outliers...sort of like the Jenny Craig commercials where they stick on the people who've lost 75pounds and then it small print it says "results not typical."

The Shrink said...

After debating the ethics of pharamceutical industries' influence upon prescribing clinicians, we've now banned all contact with the industry within our NHS Trust's hospitals.

It's surprising how much time's liberated and how you can look your patient in the eye knowing prescribing decisions have increased credibility.

Sarebear said...

The Shrink, would that be Great Britain I assume? I think NHS is them, Canada is called something a little different. Or maybe it's Canada, I get confused.

Regardless, not an entirely bad idea either, but then what do you do about samples and such?

Anonymous said...

I've never seen any drug reps in my waiting room(s). I ask for the early, early sunrise appointments and these folks have a more-laid-back schedule. But I do see evidence of them--the plastic toys and novelty pens and magnets and post-it notes everywhere. I don't get upset about it anymore. I figure I'm the consumer and I have a big voice in what pahrmaceuticals I'm going to take. Pens and coupons aren't going to sway me--I'm just glad Congress cracked down on those golf weekends drug reps used to hook the docs up with.

The Shrink said...

Sarebear yes, I'm in the UK.

We don't do samples and such at all. We prescribe what we feel to be best for our patient. Our patient either gets it for free (all my patients) or has to pay a prescription charge (usually for 2 months' medication) of £7.20 (which a converter tells me is $11.20).

Giving away free samples to get someone onto a prescribed drug is seen to be a bit like being given free heroin to get you on to it, then taking the cash off the punter over the long term. It's just seen as unsavory and not done.

There is no need or role for a drug rep in UK practice, so rather than accepting them purely for their benefit (of biased marketting of their product to us) it's more wholesome just to stop meetings with them.

Sarebear said...

Thanks, The Shrink!

it's funny my word verify is "louts"


Maggie said...

I have to agree with what The Shrink said about samples being like free heroin. The lower initial cost also makes it easier to justify trying a newer, more unpredictable, brand name drug before seeing if a cheaper generic would work.
I just find marketing like that in doctors' offices disturbing. I've had some bad experiences with getting onto totally inappropriate medications, with horrible side effects, being told that "it has no side effects." Now when I hear that a drug doesn't have significant side effects, I mentally translate to "nobody except the company selling this drug has tested it."