"Gimme, gimme, gimme!" Does EVERYONE just want a free ride?

[AngelfireRN, MSN, RN, APRN]

OK, something here that has been bugging me for a while (along with other, more recent events that rankle as well). I never noticed it as much as an RN, because I never worked at a clinic for any length of time, but I am beginning to be of the opinion that everyone that darkens our door in the healthcare setting is only out for what they can get, at no cost to them.

Back when I graduated NP school, I was working for a doc who had a sample closet the size of my laundry room. Not big enough to park a yacht in, mind you, but HUGE for what it was for. Floor-to-ceiling shelves just covered in sample meds. The drug reps came by frequently, brought lunch most days, and always tried to keep us stocked. It was unreal. This doc would bag up handfuls of meds for people, usually the entire stock of what had just been delivered, and hand it off. I was amazed at how nice this seemed, but whan I got into the workings of it, I was appalled.

I would say that roughly 90% of her patients would come in and ask for sample refills. AT LEAST that many, and probably more. People would come in for rechecks and ask for more samples. People would get fighting mad when we either did not have what they needed in samples or were out (I am so sorry that Septra is not in a sample, it's on the $4 list!). Add into that that we got into trouble for attempting to ration the samples, so that MORE patients could share the wealth. People would refuse to take anything unless they got samples, saying that they could not afford it, but yet would have an iPhone, iPod, ICarly, nails, hair done to a fare-thee-well, and all the other various accoutrements that you could buy a house with in possession.

Two cases stuck out in my mind:

* A man and his wife who were, shall we say, quite healthy, were frequent flyers here. They each had several major health concerns, mostly due to their respective weights. The male was taking a very new, very expensive medication that we were hard pressed to get samples of, and he knew that we would give him first dig. One day, doc handed me the 2 sample boxes to give to him, all we had, and when I walked in, I get a baleful look and "Just TWO boxes?" Now, what I SHOULD have done is snatch them right back and tell him that since he obviously does not appreciate it, then he does not get it, like you would a child. What I DID do was explain that that was all we had. Neither of these folks worked, they refused to take steps to better their health, and they expected everything to be handed to them.

*A very ill gentleman (and I use the term loosely) brought his mother in with him for his visit. He had an infection for which she prescribed Septra. The mother told me "Well, we'll need samples of that." I explained that it was a very old med, and that there were no samples available, and she replied that he would not be taking anything, then. I never heard how he did.

Again when I went to my family doc to precept, I was shocked. He actually had people call and complain because the samples were not BIG enough! I have seen the same man for 25 years, have never once asked for a sample, have been grateful for what I have been given, and went on my merry way. It never occurred to me to ask or complain. When I ran out of samples, if they worked, I asked for a script. I though that was how it went. Silly me.

This blows my mind. We go all out to prescribe whatever the cheapest, most effective med is for what ails them, and if it is not free, they don't want it.

I know it can't just be here. Is it this bad where everyone else works?

[Keepstanding, ASN, RN]

gimme, gimme....my name is jimmy !! (sorry, couldn't resist) !!

praiser :heartbeat

[AngelfireRN, MSN, RN, APRN]

Ha, Ha, Ha, Praiser.

[Altra, BSN, RN]

You're absolutely right, it is appalling.

Especially when the patient/family have goaded the provider into prescribing abx for what is most likely a viral syndrome, and THEN demand free samples. :angryfire

[Becca608]

My doc was great when I was in nursing school and didn't have health insurance. He would actually apologize if he didn't have samples.

It was nice when I went in a couple months ago and was able to refuse the samples of a very expensive medication he was prescribing me since I have insurance.

Samples should be given to those in need, not to convince you to fill your prescription.

[Boog'sCRRN246, RN]

I'm more inclined to give samples to those who don't ask for them.

[GoalsInTransition]

On the flip side of the coin....

I have seen physicians use sample meds as both a) PR for wealthy clientele and b) a way to get in more/unnecessary office visits.

A physician I knew of gave samples to wealthy self-pay clients only, whilst directing the uninsured to "local clinics" to try their luck there. This same physician would have their secretary call clients who were given samples to come in for another "follow up" office visit, nearly promising samples as recompence. And these follow up visits were for extrmemly benign issues, believe me.

Patients can definitely be downright greedy regarding samples, but the physicians can be so too!

[AngelfireRN, MSN, RN, APRN]

I guess I never thought of that. Maybe because I have not seen that happen. I'm sure I will, if I'm around long enough.

[ParkerBC,MSN,RN, PhD, RN]

This was an excellent post. Thank-you for sharing your stories. I will have to say that I think people’s strong sense of entitlement extends beyond free samples. It never ceases to amaze me how people act. I am sure all of you have witnessed this behavior in public. It doesn’t matter: what is fair, who is right or wrong, what the rules dictate, or simply acting ethically or respectfully, people for some strange reason have a strong sense of entitlement.

When I was trying to find the right antidepressant, my doctor gave me samples of several brands in order to find the right one. He would give me enough for a three month supply. After four weeks, I was able to determine if the meds worked or not. If they didn’t, I took the remaining samples back so that they can be used by others. Now that I have found the one that works for me, I pay for the scripts myself.

I would love to say to some…so you can’t afford the $4.00 script, I have an idea…give up cigarettes for two days and you’ll have the money to purchase the medicine that will help improve your quality of life. Or how about trading your cell phone for one that doesn’t require you to pay a $34.99/ month data package.

[pennyaline]

On the flip side of the coin....

I have seen physicians use sample meds as both a) PR for wealthy clientele and b) a way to get in more/unnecessary office visits.

A physician I knew of gave samples to wealthy self-pay clients only, whilst directing the uninsured to "local clinics" to try their luck there. This same physician would have their secretary call clients who were given samples to come in for another "follow up" office visit, nearly promising samples as recompence. And these follow up visits were for extrmemly benign issues, believe me.

Patients can definitely be downright greedy regarding samples, but the physicians can be so too!

Perhaps, perhaps. I only know that through the years my own docs have given me samples of meds that would otherwise have been too expensive to purchase, as well as treat me and my immediate family on a courtesy basis, since I was in nursing school. Professional courtesy as a practice is nearly dead, but I still know of one physician who honors it. Those low cost and courtesy visits are a godsend at times, I can attest. More practitioners should do them.

[FLmomof5]

Ahhhh.... just wait until healthcare reform...then they will complain that they would have to WAIT for their free meds at the pharmacy! LOL

[SheaTab]

You bring up an interesting discussion. I have thought about this a lot and I have come to the conclusion, based upon opinion alone, that this is yet another symptom of several larger problems.

I'd like to share a few of my thoughts if I may.

I'd like to ask the nurses of allnurses.com to think about how often they utilize the Emergency Department for their healthcare needs? Based upon informal conversations I've had with my peers (MDs and Nurses alike), it would seem that we rarely use the ED for our care unless there is a significant urgent need. Many of the patients we see in the ED have no business being there, but the honest truth of the matter is where else would they go? Many of these patients present and demand far more services than those of us who have insurance would think to ask for, for example, CT scans, ultrasound, and a myriad of lab tests. The ED has become the primary care for the uninsured and underinsured of our country. I hope that healthcare reform, providing that it covers all citizens, will alleviate much of the financial and time constraints placed on hospitals across the country. Poverty and lack of education seems to have a significant relationship to over-utilization of healthcare-related services.

I often wonder if we are inadvertently encouraging and even positively rewarding this abuse of our already over-burdened system by honoring the unreasonable requests of some patients. Are you familiar with the article published in The New Yorker magazine entitled The Cost Conundrum: What a Texas town can teach us about health care? It is a curious condition that a town that has the lowest household income in the country also wins the prize of 2nd most expensive healthcare markets in the country!

Check it out: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

Part of the problem seems to be related to provider overuse as well. In the example given from McAllen, Texas, it would seem that many providers are offering as many services as they will be reimbursed for even when the services may not be necessary for a given complaint. We have all witnessed this at some point or another. Every time I work, depending upon the physician working, I have wondered, "Why are we admitting this patient?" Surely this isn't my unique experience.

I was talking to an ED physician last night about this very same thing. He is from the Appalachia area and said that his hometown is a lot like McAllen, Texas. Most all of the families there are well below poverty and his personal opinion is that they seek treatment more than he has seen in any other locale!

I do believe that all citizens should have access to high-quality healthcare, but I also believe that we might benefit from modifications to the infrastructure that supports over-utilization of the system by both patients and providers. Over-utilization on both counts is no free ride since taxpayers will end up footing the bill in the end. For example, a cough and cold for me and any member of my family will be treated with OTC meds if absolutely necessary, plenty of rest, a lot of fluids, and TLC. If the symptoms worsen significantly then a visit to the doc/NP may be in order, but that is extremely rare. I can't even remember the last time I've taken antibiotics. I have no evidence to support it and it may be a slippery slope to even say this, but I have wondered if providing something absolutely free has resulted in abuse of the system. For myself, I will not access the system unless I absolutely have to because I need every penny I earn to pay my bills. That being said, even if the service were free to me, I highly doubt that I would over-utilize the system to a great degree anyway. This leads me to two logical conclusions:

1. Some folks over-utilize because they can.

2. Some folks over-utilize because they have a knowledge deficit regarding effective use of our healthcare system and the benefits they can expect to gain.

I'm not sure what can be done about the first conclusion. Perhaps extensive reform is necessary in our medicare/medicaid system. For example, what about having triage nurses in the CMS system that function to evaluate recipients health-related complaints and to make recommendations for follow-up. I know this idea is wrought with variables that would make this a mess from the start!

I used to work in L&D and I had a patient once who came to be evaluated in triage for onset of labor. She arrived via ambulance. When I called the MD to give her report on this patient, she was enraged that the patient had taken an ambulance to the hospital. She had just seen the patient in the office and had told her to go to the hospital at some point in the day to be evaluated but only because the patient insisted that she was having contractions. There were no signs that she was in actual labor. The patient asked the doctor to call EMS for transport, but the doctor said that since there was no actual emergency that this wasn't necessary. We have a widely available public transportation system in the metro area. The patient left the office and immediately called an ambulance to bring her to the hospital. I also work in the ED and we receive patients all the time via EMS who have no business using ambulance services for minor complaints. OP, I'm just not sure what to do about this pervasive problem except to educate. In the case of EMS, I'd suggest a nominal fee to transport non-emergent patients. This would certainly cut down on this awful abuse. It is a significant contributor to burnout in the profession because these same patients have been known to make unreasonable requests and also occupy beds that could be utilized for sicker patients. In addition, the problem can lead to overgeneralization and stereotyping within this demographic. This could lead to assumptions and lessor care. There was a recent study that found that uninsured trauma patients had a higher mortality rate than their insured counterparts. http://www.msnbc.msn.com/id/33971846/ns/health-health_care/

We had a patient come in three times yesterday via EMS with the same unfounded complaint. What a mess!

In terms of handing out gobs of samples, many major healthcare systems across the country have moved away from accepting samples from drug reps at all. I can see the merit of offering samples to those who simply couldn't afford their medications at all, however, in most cases, there is a suitable alternative on the $4 list.

Now, and in the future, we are going to have to insist on patients becoming partners in care. What is going to happen when more and more Pay-for-Performance measures are implemented with regard to dealing with patients who are non-compliant with their therapeutic regimens? I would be hard-pressed as a provider to continue a relationship with a patient who was unwilling to partner with me. I can imagine that I would be inclined to make this known from the onset of the relationship.

I feel your pain!

As a nurse, I would also be inclined to sit down with patients and look at their overall expenditures and talk around what they would be able to cut out (cell phones, cable, etc.) in order to afford their medications. I wish there was an easy answer but until patients are required to responsibly utilize healthcare services and providers stop over-utilizing, I just have no idea. I hope all of this is being extensively evaluated on Capitol Hill.

Best of luck to you!

Tabitha