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 am positively giddy that someone has spoken so frankly and articulately on the topic of over-utilization! It happens at both ends of the socio-economic spectrum in my experience- the poorest people and the wealthiest (with "premium" coverage) each have their own reasons for demanding high-cost medical services, and this cost is passed on to the rest of us.
In the case of impoverished persons, I have seen countless examples of demand for medical services, and a feeling of entitlement because one is covered by Medicaid. These people often have no concern whatsoever that this cost is borne by everyone else- taxpayers, namely, whether insured or not.
Americans are so adamant that medical services not be "rationed", each fearing that they (or their loved ones) will be cut off without necessary treatment; this fear keeps us from rationally examining how we can efficiently get NECESSARY care to all who need it.
Any rational person should be able to acknowledge that not everyone will be able to get everything they want from the healthcare system- sharing cost means sharing services, and an adjustment in what we feel we are entitled to.
Those pharmaceutical reps make me sick!!! I did a clinical (nsg school) in a endocrinologist office and the RN told all about how they work and their motives. She knew which pts were most in need of samples and would make sure they were the ones who got them. Also, when the reps brought in lunch (every day) she would give them guilt trips about how much their drugs cost and would give examples of the pt's who couldn't afford them, ect. She was an awesome nurse!!
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.
i dont think this is what the poster you quoted was alluding to. She specified wealthy uninsured clients would get the "check up" appts....this means the doc was getting the money up front.
I was referring to a physician who was using samples to drum up some extra business (billing for the follow-up visits that were pushed onto patients who wanted free samples but could easily afford to purchase them), as opposed to bestowing a professional courtesy. Yuck.
i dont think this is what the poster you quoted was alluding to. She specified wealthy uninsured clients would get the "check up" appts....this means the doc was getting the money up front.
I understand that. I was presenting the case not so much for either side as for those "in between." Giveaways have their place in medical treatment, and "gimme gimme" is not always an outrageous expectation.
This attitude of entitlement is glaringly apparent in the ED. I am still continually amazed at the people who call the ambulance for a stubbed toe, then carry on loudly their entire time in the ED, while there is another patient down the hall who is actually dying, has received a diagnosis of terminal cancer, or who is extremely sick, who is demanding nothing. For some people, it is all about me, me, me.
It would be one thing if this were an anomaly, but on the contrary, it seems so pervasive.
Specializes in med-surg, psych, ER, school nurse-CRNP.
I understand that. I was presenting the case not so much for either side as for those "in between." Giveaways have their place in medical treatment, and "gimme gimme" is not always an outrageous expectation.
It can be when it's the opening line at every visit.
Maybe I'm in the minority here, but I was taught that I had to EARN my way and that my success or demise in life depended largely on what I was or was not willing to do. I can not tell you what those values have done for me. I am where I never thought I would be in my life, at the point in my life that I am. I have the very real possibility of owning my own beach house in Florida, I have a great hubby, 3 furbabies, and a great family. All of this is by my own doing, (well, except the family and the hubby...I lucked out there). Yes, I had help. My parents pushed me into NP school, they paid my tuition. That was their gift to me. In return, they are getting free healthcare for the rest of their life, at least from me.
If something is offered to me, I will in most cases accept it and be grateful, then either try to pay it back or forward. My doc, for example, knows that, now that I know he likes brownies, he can look forward to a plate of them every time I come for a visit, unless I am at death's door (and, seriously, would YOU really want me cooking for you in that state?). If I can do for someone that has done for me, I do. I do for folks that have not done for me. It's how I was raised. BTW, completely off-thread, but is it just a Southern thing now to take food everywhere?
But this is not the norm.
I have never expected a free or courtesy visit from a healthcare professional in my life. If I was on hard times, I made payment arrangements, then sold something so that I could pay my way. I don't think that courtesy visits are the answer. Healthcare providers have bills to pay too. I know I do. I don't expect my credit card bills to be forgiven because I was in school and unemployed when I made the charges.
I guess my take-home point is that I can not fathom how we got to a point in our society that something for nothing is not only expected, but DEMANDED. And moreso, how it came to be the accepted norm, why it is catered to, and how much worse can it get before it implodes.
I REALLY need to get my quilting back out. I'm getting too het up over things. Thanks for reading. Im loving these comments!
i was always under the impression that the main 'purpose' of a sample was to ensure that a patient did not have some type of reaction before they went and shelled out money for the rx.
it would suck to try a new med, then realize you could not take it, for whatever reason, and then have to shell out more money for another rx.
my doctor gave me a sample of a new asthma med and said "try this, if you like it and it works well you can fill the rx. if it is not working out call me, and we can try something else."
this phrase is thrown out a lot, but in some cases it is very accurate. some people feel a sense of "entitlement", for whatever reason.
"maybe i'm in the minority here, but i was taught that i had to earn my way and that my success or demise in life depended largely on what i was or was not willing to do."
agreed! barring any major disability, developmental disorders which cause mental retardation, etc.. people should be expected to earn their way in life, and their success or demise will often be their own fault.
anyone can have a wrench thrown in their gears, and that is what a safety net is for, but a safety net is not a hammock! it is not for long term use.
btw, completely off-thread, but is it just a southern thing now to take food everywhere?
rice krispie treats in the shape of xmas trees is my favorite goodie to bring!
"what your not going to give me the samples of those little blue pills" yep like that was the most important part of the visit.
i have seen the good and the bad of samples and truthfully a lot a patient’s believe they have the right to have them supplied. truthfully i have worked with a large amount of patients that those samples were a god send. gimme, gimme, gimme: sounds about right. it’s not all the drug rep’s fault; there is the doctor and the patient that also went merely down that path.
only one doctor i know ever did the professional courtesy thing... it was much appreciated.
as for the attitude of entitlement: i have seen/heard patients in the clinic that stated if i have to wait that long i’ll just go to the er. i have heard this same thing over and over the last 20 years. when something is gained at no cost and comes with rewards, of course, it will grow out of control.
GoalsInTransition
96 Posts
Thank you!
I am positively giddy that someone has spoken so frankly and articulately on the topic of over-utilization! It happens at both ends of the socio-economic spectrum in my experience- the poorest people and the wealthiest (with "premium" coverage) each have their own reasons for demanding high-cost medical services, and this cost is passed on to the rest of us.
In the case of impoverished persons, I have seen countless examples of demand for medical services, and a feeling of entitlement because one is covered by Medicaid. These people often have no concern whatsoever that this cost is borne by everyone else- taxpayers, namely, whether insured or not.
Americans are so adamant that medical services not be "rationed", each fearing that they (or their loved ones) will be cut off without necessary treatment; this fear keeps us from rationally examining how we can efficiently get NECESSARY care to all who need it.
Any rational person should be able to acknowledge that not everyone will be able to get everything they want from the healthcare system- sharing cost means sharing services, and an adjustment in what we feel we are entitled to.