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?
I think most of us are smart enough to determine who is truly in need and who has a sense of entitlement. Sorry, but like others have said, if you come in with an iPhone, nails done up and pull into the parking lot in a fancy car, you have little reason to complain about costs of meds. We all are aware that there are some people on welfare/medicaid that truly need it, and there are those that work the system.
IMO, your health should be your priority not your nails, your cell phone, and your nicotine addiction. I'd be perfectly happy if they disallowed the use of samples out of doctors offices-it's way out of control, and it's a conflict of interest in many cases. What they could do is this-in order to be eligible for samples, you have to get on a mailing list and would have to provide proof that you truly are in need. Or, they could limit everyone to a certain amount of samples(maybe 2 or 3 times in a year)-you'd have to sign a form to keep track.
Angelfire, great post..you have this knack for posting topics that get everyone talking. True, you get the "holier than thous" too but at least the threads aren't boring.
I think most of us are smart enough to determine who is truly in need and who has a sense of entitlement. Sorry, but like others have said, if you come in with an iPhone, nails done up and pull into the parking lot in a fancy car, you have little reason to complain about costs of meds. We all are aware that there are some people on welfare/medicaid that truly need it, and there are those that work the system.
IMO, your health should be your priority not your nails, your cell phone, and your nicotine addiction. I'd be perfectly happy if they disallowed the use of samples out of doctors offices-it's way out of control, and it's a conflict of interest in many cases. What they could do is this-in order to be eligible for samples, you have to get on a mailing list and would have to provide proof that you truly are in need. Or, they could limit everyone to a certain amount of samples(maybe 2 or 3 times in a year)-you'd have to sign a form to keep track.
Angelfire, great post..you have this knack for posting topics that get everyone talking. True, you get the "holier than thous" too but at least the threads aren't boring.
I was always under the impression that samples were used only to determine a drug was going to work and if it was the right one for the individual patient. Why not just use samples as they are intended. Give the patient enough to figure out if it works for them and then give them a prescription. If they cannot afford the drug, put them in touch with the drug company so they can get on one of the programs drug companies offer for people that can't afford the drug. Patients and care givers have an equal responsibility to contact state representatives with regards to this issue. Perhaps a standardized form designed for communicating with representatives could be given to patients with this issue as well as for the provider to send to their state representatives. Leave blank lines for the names of patients and various drugs in question so it can be filled in and then sent in to the appropriate offices that can actually do something about it. There will always be people who will find a reason why any potential solution won't work. I think people need to be more proactive and less reactive.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
Dials? Convection ovens? What are those? Just kidding. . .my experience has been that a person of any age who adopts an easier, faster way of doing something will be very loathe to return to the old way. I stubbornly defended my old dial-up internet connection to all who dared bring up the subject, for years! Then I "had" to use a hi speed cable modem, wi-fi and a laptop due to my mean old son wanting to play his video games Guess who was the most annoyed and tapping her foot at her mom's archaic computer yesterday??? ee-yup, me!
However, the thought of libraries and actual books becoming obsolete strikes terror in my heart. I love books and libraries. They are so much more than the transfer of information. I both fear and covet the Kindle.
Back to the sample issue- yes- in the strictest sense they are a short term supply of a drug to determine their effectiveness. In the case of anti-depressants, this classic use is ideal because of individual variations and sheer number of anti-depressants out there.
On the other hand, I don't remember a time (my first clinic job was in 1978!!) when lots of factors weren't at play in the drug rep-sample giving-patient relationship. The samples actually are a form of currency in a way. Providers get to know their patients, they know who is really up against it, and I see nothing wrong at all if they choose to give these people more than their "fair share" according to somebody else. A dermatologist I worked with would practically tackle the Westwood Pharmaceuticals lady in the hallway to get Keri lotion for the nurses, same with the Neutrogena. That really never struck me as morally repugnant.
I do agree that ragging on the drug-rep for the evils of Big Pharma is pointless. Kinda like interrogating the bank teller for misuse of TARP funds. Anyway, as I see the freebies as currency- they can and should be scrutinized. The much bigger problem is the Pharm companies circumventing laws intended to prevent undue influence. Like with political donations, they will find a way. Providing free food was not done when I worked in clinics/drs offices. Maybe they started that when they banned evil scratch pads and calendars. I don't know.
When pharmaceutical companies started providing samples, sometime in the late 70s, they were antibiotics, which doctors gave impirically, or pending culture results. That was appropriate. The companies realized at their fiscal year's end, that they could use the retail price of the sample medications they provided, as a huge tax deduction (business expense). So that, as well as escalated "street" plying reps (usually attractive, well dressed women in high heels and short skirts, and dapper suited men) providing educational programs advancing their drug "of the day", social functions when dinners with wine occurred (never mind if a doctor attending same, was on duty) also brought tax relief, and allowed them to increase their drugs' prices, saying they were marketing tools.
As if that wasn't enough, they got away with claiming research costs as tax deductions, without revealing the grants that paid for same, as income. So all their other products went into expensively, attractively wrapped
sample packages. No tracking of which doctor got what has ever occurred, unless the medical offices did it themselves; and no guidelines have been given doctors, other than a hazy agreement that those who had insurance as well as those without that, would get the samples. Those doctors with a highly developed sense of conscienciousness, determined that their uninsured patients who couldn't afford to pay for their medications, would benefit from them most.
When their patients got word of the potential windfall, especially those on Medicare whose finances couldn't sustain expensive "supplemental" plans, doctors were deluged with requests for drug samples, and assigned the determination of who should get them, to their less educated medical assistants, occasionally to nurses, and sometimes receptionists. Those people, who earn paltry salaries, based their judgment regarding who could and couldn't afford to pay for prescribed drugs on items patients have, such as manicures, possibly expensive clothes or a handbag (which could be 20 years old, purchased at a yard sale or consignment store); and if they saw it, their vehicles (which could have been borrowed). Many times service providers barter their service for another person's (such as masseuses who gets manicures from a non paying client who is a manicurist). Car salesmen take new vehicles home, and occasionally lend one to a relative...... get my drift?
It has also happened, that patients who were found less congenial with the staff providing samples, didn't get the free medicine they desperately needed. I find the means expressed in other posts, for discerning who does and who doesn't get samples, despicable. :angryfire
Specializes in Peds/outpatient FP,derm,allergy/private duty.
A drug rep that comes in regularly to refill the sample closet knowing they will be handed out by a receptionist doesn't seem logical to me because the goal of the drug-rep or "detail person" as we called them in the old days was to get the doctor to write prescriptions for the drug. I'm not seeing the incentive for the company to make sure people are getting their stuff free for an indefinate period of time.
I've never worked for a place in which the doctor was completely out of the loop in the sample giving. It's a really bad idea to have ancillary people unfettered access to prescription drugs. It sounds akin to a racket operating from a doctor's office.
I'm still on dial up and drive a 15 year old car. While I don't have a cell phone, iphone or other modern gagitry, I do have $20,000 in medical debt because I'm self pay. Funny how I don't have any other debt no credit card, mortgage, car payment, etc. just the medical debt. I would certainly have more but it's struggle to get this paid off. There have been many times that bankrupsty was thought of but I realize that it would only take care of this debt and not the ongoing debt from having pre-existing conditions and choosing to work instead of going on disability. I know of many people who have chosen disability over getting employment just for the medical benefits. Its sad when people have to chose not to be productive just so they can get their medical needs met. This is especially true when so many see them as "milking" the system.
Guess who was the most annoyed and tapping her foot at her mom's archaic computer yesterday??? ee-yup, me!
GadgetRN71, ASN, RN
1,841 Posts
I think most of us are smart enough to determine who is truly in need and who has a sense of entitlement. Sorry, but like others have said, if you come in with an iPhone, nails done up and pull into the parking lot in a fancy car, you have little reason to complain about costs of meds. We all are aware that there are some people on welfare/medicaid that truly need it, and there are those that work the system.
IMO, your health should be your priority not your nails, your cell phone, and your nicotine addiction. I'd be perfectly happy if they disallowed the use of samples out of doctors offices-it's way out of control, and it's a conflict of interest in many cases. What they could do is this-in order to be eligible for samples, you have to get on a mailing list and would have to provide proof that you truly are in need. Or, they could limit everyone to a certain amount of samples(maybe 2 or 3 times in a year)-you'd have to sign a form to keep track.
Angelfire, great post..you have this knack for posting topics that get everyone talking. True, you get the "holier than thous" too but at least the threads aren't boring.