Quilly, funny you should mention that. Steve Kroft of 60 minutes recently did a expose' on how congress also dictates trading based on inside information but it's perfectly legal for them to do it while people like Martha Stewart go to jail. It's why most politicians start out poor and end up so wealthy. They hear about something behind closed doors and can LEGALLY trade based on that information. I think that is criminal as well.

Here is a link that might be useful: Congress allowed insider trading while other go to jail.

Most of the Physician's office on the floor I work on have signs on the door that say "No Sales Reps. Thank you."

Lynn, I couldn't have said it better.

I don't know of any doc's that have ever gotten "kickbacks" for drugs. There are docs that get paid for speaking on behalf of a certain drug.

Like Lynn said. They used to bring pens and pads along with lunch to get the opportunity to tell the doc about their product.

It says a lot that so many people feel they would prescribe dangerous drugs to people for pens, pads and lunch. I guess a lot of people could be bought of very cheaply, but I don't know many physicians that are that cheap.

It is illegal for the doctor to accept gifts from a drug rep.

If your doctor is that much of a scumbag, you really need to find someone else.

lukkiirish - I saw that program too and it sickened me. many members of Congress are lining their pockets with profits based on insider information. If I ever had respect for politicians it stopped after that show. What's really sad is that they often vote for something that's not necessarily in the best interest of the nation but because they can make money.

It should be illegal - pure and simple and the fact that Congress allows it to continue is quite telling about where their interest lie.

Lynn, my DH was a Pharmacist and is now a practicing GYN Oncologist. I agree with every word you said.

Work, you can't imagine a patient asking for a drug they've just read about or seen advertised?.....this happens so often after an article in Good Housekeeping, Redbook,etc. prints a piece on a female health issue praising a new miracle drug.
I always warn my husband ahead of time to be prepared for the requests either in person or by phone. And it sure happens.

Lynn, thanks again for telling the other side of the story.

Quill, my sentiments exactly.

Oakley's comments were so upsetting that I couldn't respond logically yesterday - I'll try now. But I doubt I'll be able to match Lynn's elegant reply.

What a sweeping condemnation of physicians!

You complained that 2 posters here made assumptions about your medical condition. Yet you have made a huge assumption about physicians - "I want to preface this by saying not all doctors take "kickbacks" from pharmaceutical companies. But it's common knowledge doctors get a lot of goodies for prescribing certain drugs that pharm. companies push on them."

Wow - How could you ever trust a physician if that's what you believe? What bribe do you think your doctor received from the drug rep for switching all of his patients medications?

You also stated "It seems pretty obvious that doctors are getting some really nice gifts from the pharmaceutical companies. I see their rep's there all the time." Just because the rep is there doesn't mean the doctor is getting gifts. Do you see a conspiracy in everything?

It's both unprofessional and unethical for your pharmacist to be commenting about what medicine a doctor prescribes to other patients. For one thing it's doubtful he fills the prescriptions for every patient this doctor sees even if they are in the same building. Many people will take the script to a pharmacy closer to home.

DH is a hematologist/oncologist who has been practicing for over 35 years. This is an individual who spent 14 ears in school for this profession: 4 years college, 4 years Med school, 1 year internship, 2 years Internal Medicine residency, and 3 more years in a subspeciality Hematology/Oncology Fellowship.

I can't tell you the thousands of times he has missed dinner or his children's school activities because he had a medical issue he had to handle. Or the number of phone calls he had all night long from patients who needed help when he was on call. Or the hundreds of time he got up and drove to the hospital in the middle of the night to personally care for a patient who had been admitted.

It always amazed me that he would answer all of those middle of the night phone calls with such patience, especially since many of those calls could have waited until morning. There were people who called because they were hungry at 2 a.m. and wondered if they could have dairy products if they felt queasy. He would respond in the same reassuring tone as he did with those patients who were having serious medical issues.

He has been selflessly devoted to his patients. I asked him if he had ever been offered a kickback from a drug rep and he looked at me in amazement. Never. I told him about this topic and he just shook his head and said that it was unfortunate that someone would have such an ignorant view of the medical profession. He thought you might have had a terrible experience with a doctor which caused you to lose your trust or that you harbor some personal bias which would explain your belief that doctors are accepting cash or kickbacks to prescribe certain drugs.

He knows that drug reps have a job to do and he does appreciate it when they leave samples that he can give to patients who have trouble paying for their meds. Unfortunately in his field there aren't many oncologic meds that can be left as samples. He puts in long hours and doesn't like to give up any time to spend with the drug reps.

It's sad but there are people who come into the office and request a medicine that they saw advertised on TV or read about in the newspaper. Just think of how many people believe that they need an antibiotic for a cold. He has had patients come into the office with pages and pages of reports they have printed from the internet and want to discuss. So often these articles aren't even about the condition that the patient has.

Now if you really want to become irritated - why not direct your anger toward the entities that won't let DH practice medicine in the best way he can. The federal government and insurance companies now dictate which medicines he can prescribe. Here is an example - Medicare now routinely denies Aranesp injections because it's an expensive drug. They will allow Procrit - however it has to be given more frequently and for those patients who need the Aranesp it is less effective and in the long will cost more to administer. When Medicare denies a drug then insurance companies follow suit. He is now spending more and more time on the phone with insurance companies trying to get them to approve the medicine that is the most effective for his patients. This is happening to physicians everywhere. He feels it more acutely in his practice ecause chemo drugs are very expensive.

I hope you resolve your situation. My only suggestion is that you should talk in person with your physician and ask the same questions you asked here. Ask him why he switched meds. Get the answers that you need. Be proactive and informed.

In defense of Polly and Tina (who probably don't need me defending them, but have a thing about unfair jabs with or with that lol that is often added):
Uh, with all due respect Polly and Tina, what is "complicated" about my health?
From your Paula Deen thread: For those who think they know all about diabetes who do not have the disease, it's a tricky illness.

I am so pleased that we have folks here standing up for the docs, and rightfully so. The kickback crap is not true, at least not now. Besides the federal regulations, the docs I know would not consider compromising a patient's health for the sake of a free dinner, and often tell the reps that they don't use their meds and prefer something else. But the reps also bring the docs updated information on medications and developments that might BENEFIT the patients, but that the docs may not have had time to research for themselves.

The docs I worked for had to even stop accepting the pens and notepads that the reps brought. The ONLY thing that continues is the free lunch for the staff here and there, and that is when the reps get a chance to have lunch with the doc and talk about their meds. Otherwise, the docs I worked for would not even talk to them. I NEVER saw patients waiting while a doc talked to a rep - they did that on their lunch time, and it was scheduled months in advance.

The free samples benefit the patients, period. And those are fast disappearing in many cases.

Are there abuses? Of course - that is true in any profession.

My sister-in-law is a doctor in Family Practice. She's not getting kick-backs from anywhere, not if the 10 and 14 year old cars that she and my brother are driving are any indication.

The most I've heard of her getting are a few dinners here and there, a few stuffed toys that look like blood cells or bacteria, and pens and note pads.

When it comes to prescribing medications, she spends most of her time either a) learning about new ones that have come on the market, to see if they might help some of her patients and b) trying to remember which insurance company covers which medication. Her practice takes over 20 different insurance plans and some of them change the approved drugs monthly. She's constantly getting phone calls from pharmacies to tell her that the drug she's been prescribing to a patient for years is now no longer covered and does she want to change it for a generic or prescribe something else.

Before leaping to the conclusion that a doctor is prescribing a drug just to get a kick-back, I'd ask the doctor why the change is necessary--what does the new drug do that the old one didn't, has my condition changed enough to warrant a new drug, are there insurance coverage issues, etc. My chief complaint with doctors is that they don't explain these decisions enough and that they get annoyed with me when I ask the questions.

This has been an informative read. Thanks to all who tried to open eyes.

Oak; I hope you find a new Dr. I've dealt with a few like this who prescribe certain meds & I have no clue why they do this. One psych my daughter has seen for years; he had her on lexapro. At the end of hub's cancer treatment; he also was given Lexipro. Both of them had the same side effects with it & hub's physicians assistant changed him to Effexor while daughters psych told me; nope; I don't use that & gave her Cymbalta. The Effexor worked well. With my daughter; I did not see a change & 3 months later; she's complaining of back pain. Long story short & now 2 year later; she's finally off of Cymbalta but the back pain continues. I looked up Cymbalta & it's a side effect... The psych has refused to see her & I'm sure it was a blessing but child psychs are very hard to find here; especially in network.

I recently started with new pain management; who wants to put me on Cymbalta & I'm scared to try it with my current muscle & bone pain after what my daughter has gone through. My daughter seems to have the same side effects to medications that I do; including antibiotics; yet I find out that the new PM Dr put it in my file that I'm refusing to do what she suggests. I'm now debating writing her a letter to spell everything out but don't know if it will help. I go to a teaching place & wonder if what I tell the students is not being written down correctly. I found out what was written because of PM's notes to my Dr; who actually knows my history.

I'm just so fed up with Drs. Our finances are depleted & I don't have the cash to jerk around right now.

I also want to add a few comments, based upon a few notions I have read in these threads. I base these upon some personal experience having done patient-based clinical drug trial research and being a doctor in an allied health profession.

(I am not defending pharmaceutical companies, where corporate waste is high, or doctors, in particular)

With regards to "dangerous" drugs being prescribed [for kickbacks or whatever reason]. There are very few "dangerous" drugs on the market in the US. The problems arise from the inappropriate use of drugs or unforeseen drug interactions. Why are drug interactions unforeseen?

When drug trials are done, the study patients meet strict entry criteria. Any pregnant patient or patient with liver or kidney disease or heart disease is ruled out (unless the drug is related to these conditions).The young and elderly are ruled out. Most patients who are on other prescriptions drugs may be ruled out depending. Many patients who have conditions not treated by drug may be rule out --migraine sufferers etc.

When the drug goes onto the market, the drug will be administered to people with liver, kidney, or heart disease; people who are on a host of other medications, women who are not preventing pregnancy, and the elderly. And this is where a new set of interactions start to show up. There is no way to test for some of these interactions in the drug trials.

However, I DO know that every potential interaction or adverse event is recorded during the study even if you are almost certain it had nothing to do with the drug itself. (Broken Arm).

The most devastating interaction I can think of is Thalidomide and Phocomelia,(1960-62) the condition of babies being born without limbs or with partial limb development. However, the Americans who took Thalidomide and had these children were mostly in the armed services in Europe. The drug was not approved for the market in the US. One of the reasons that drugs are cheaper outside the US is that both the research regulations and manufacturing controls are looser.

With regard to drug reps:

Personally the idea that I am going to prescribe a medication for a bunch of pens or going out to dinner with someone I don't even really know seems ludicrous, but I suppose it happens.

Based upon my experience, a drug rep stops into the office, or more likely calls, and the receptionist says "the doctor is with a patient, if you have literature you can drop some off". The receptionist has actually said this when I am at the front desk writing up patient notes :) I don't look very "doctor-like" I guess.

I have met with reps by appointment if I have a lunch break, but this is only to hear about something I know I am already interested in. But compared to the corporate day where a certain amount of schmoozing seems to be built into the schedule (studies have shown about 40% of the corporate day is non productive, and that smokers spend almost 2 hours a day either getting ready to smoke, smoking, or coming back from smoking if they work in a "smoke-free" environment)

---compared to corporate, most doctors, if they are at work, --are working. If I am in the office 5 hours, that means I have 5 hours of patients scheduled, and some days that means I "hold it" instead of using the rest room for five hours.
I don't have time to listen to a random sales rep.

What we Are guilty of is this :
Using the same meds over and over because we are most familiar with them.
Trying a new med because we have read about it and it sounds promising and the only way to find out for ourselves is to prescribe it.

AND--we are hampered by Insurance, and peoples' Ability or WILLINGNESS to pay. I have patients who can't afford the better medication, I have patients who could but will not pay for the better medication if it is not covered, and I have had insurance companies deny the better medication. I have had the Doctor at the insurance company tell my to prescribe X because it is therapeutically equivalent to Y, and I have said in response "IF you are in practice, and you are telling your patients this or prescribing it this way you are committing malpractice"

Not sure if you (Lyn and Quilly) been in your hubby's office recently during lunch when a pharmaceutical representative stopped by.... I personally witnessed one representative bringing box lunches for the entire office several weeks ago. I have even seen Rx pads already made out for their medication and the doctor just has to sign.

WhiteRiverSooner ..... Please can you site the legislation that references "illegal for the doctor to accept gifts from a drug rep". Since I'm not familiar with this piece of legislation.

Bottom line is ...... and nothing wrong with it ..... just how sales people operate ..... PHARMACEUTICAL REPRESENTATIVES GIVE THESE GIFTS (Lyn's hubby's knee and eye)TO GET IN THE DOOR AND TO BUILD A RELATIONSHIP WITH THESE DOCTORS!!!!!

Pharmaceutical representatives are not handing out "experimental" drugs. These drugs have been all approved by our Government. So what is the big deal anyways?

And yes I have major trust issues with doctors as a whole since many are IGNORANT when it comes to rare/orphan disorders....However I loved and trusted my geneticist in Maryland; the smartest doctor in the world (and famous too). My Hopkins hematologist I also trusted with my life (literally) during some major surgeries.....My trust issues are out of the doctor's ignorance not his/her acceptance of pens,note pads, or even lunch from drug representatives.

And no I am not a doctor nor pharmaceutical representative just an Electrical Engineer with many genetic mutations. :)

" Rx pads already made out for their medication and the doctor just has to sign"

I worked in a medical office and it's not unusual to have a prescription pad made out with a specific medication on it - when it's a common drug prescribed in that office. It just saves a little time.

I have even seen Rx pads already made out for their medication and the doctor just has to sign.

The last few times I've been prescribed something it was done via computer from the doctor's office to the pharmacy. I'm surprised the pads are still in use.

Tex - what does it matter if Lynn has been in her husband's office lately? She already told us what goes on there. I think she would know. So what if they get an occasional free lunch/dinner??? That is quite a common sales practice.

Cyn - thanks! Apparently I need all the help I can get.

I didn't make an assumption about Oakley's illness. Neither did Polly (hope you don't mind if I speak for you Polly). Diabetes is a SERIOUS illness and should be taken seriously - whether it is Type I or Type II (not A or B). My sister was head of a diabetes clinic and now works as an educator for diabetes and insulin pumps. I have two relatives who are pre-diabetic and I know how serious their doctor has taken just the "pre" situation. Polly works in the medical field and cared for a relative with diabetes. Honestly, if it were me, I would not be happy seeing a GP for diabetes. I would seek out an endocrinologist or an internist. I have never heard that diabetes can go away or be cured??? My own father just recently had high numbers and has been closely watched by his doctor the last several months. Dietary changes made a big difference in his numbers, but even though he is only "pre" diabetic, he was told this is something he will need to control and pay attention to the rest of his life.

Oakley, it's like Polly said, you ask for opinions, they you take offense and attack. You need to think about people here who are in the medical profession and those who are married to physicians. How do you think this made them feel? I could bring up thread after thread where you do this. Lynn, Mitch, Polly and Pal were very kind to share the other side. I do agree there are bad and good in any profession. It is up to us to research and find a doctor. I am thankful I can honestly say that our doctor puts our health first. He works long hours. He is available when we call, etc. I would never offend him with the assumption that he is taking kickbacks! And btw, I don't think of gifts when I see that word. You need to be careful what you acuse people of.

Oh - I don't believe any of our doctors use prescrip pads any longer either - it is of benefit to them - and us - to use the computerized method. My gyn does her straight from her smartphone.

tina

Once diagnosed, a person is always a diabetic, even if they change their diet and exercise and do not have to take insulin or pills.

The "free lunch" is sometimes provided by a sales rep who is having a meeting with the whole staff during their scheduled lunch break because the office will not block out time in the patient schedule to see a sales rep. It's a way of insuring that the staff or doctor won't further cut into their time by going out to get something to eat and then meet with the rep in an even shorter time period, since it is provided.

And yes, the pre-printed prescription is a matter of convenience for commonly prescribed drugs and dosages, although the only ones we have now are for non-prescription but behind the counter drugs. I have never seen one for a scheduled drug (one with potential abuse potential) and know that it some states it is illegal to use pre-printed pads for scheduled drugs. We are also on computer in both offices. There is certainly no incentive provided by the company for using a printed pad.

Hey Tina my point too. My words "So what is the big deal anyways? " Why not consider the feelings of people here who's professions are in sales or even advertisement? This last statement isn't directed at you. Tina also I'm a "pre" any suggestions and how to get my Endo to correctly test, i.e. GAD antibodies.

My Dad almost died because of diabetes. He is very thin. My Dad has type 1.5 (LADA, Latent Autoimmune Diabetes). Are we forgetting about this type. Approximately 20% of type 2 are misdiagnosed.

Roseabby, I had gestational does that mean I am a diabetic? ... I actually think I have auto immune, like my Dad (it runs in his family but his family received a type 2 Dx). Additionally I (and my son) have Hashimoto's which is autoimmune thyroid. My Dad is being tested for Hashimoto's but I can not get my Endo to properly test for auto immune diabetes .... Any suggestions? I see my Endo every 3 months for bone (Rx injections), thyroid, and vitamin D issues.

Tex, I was referring to type I and II. Gestational diabetes typically goes away at birth of the baby but it leaves the mother at MUCH higher risk of developing type 2 diabetes later in life is what I have read.

I also think my doctor at Georgetown Hospital is wonderful. He works long hours, but always takes as much time with me as I want. He has given us his private number and I was even able to reach him in his office on that number one Sunday when I was expecting to reach his machine. He does Rx on the computer now, too, btw.

Tina, thanks for pointing out it is Type 1 or Type 2 Diabetes. Texask, never heard of 1.5. Interesting.

Truth be told, I have never had a doctor who wasn't dedicated to giving his/her patients the absolute best care possible and that is true of the many who took care of my family members as well as friends in the profession.

Roseabbey thanks. That is what one of my internists in Maryland stated too. He also said I could not have diabetes because I was too thin and too old (at the time I was 28). My Dad is too thin too and older than me. This internist had autoimmune (type 1). He died because of complications from his diabetes. Wonder why doctors dismiss type 1.5 .... Latent Autoimmune Diabetes....maybe ignorance (not knowing there is a type 1.5)?

Tex - I get what you are saying - was just wondering what the point was towards Lynn. Anyhoo - I've never heard of Type 1.5 - that is interesting. If you can't get your doctor to do the testing you think you need (and it sounds like you have a very valid point), I'd find someone else. At least get a second opinion. As for being thin, I thought losing weight could be a symptom of diabetes?

Sadly, I did go to a doctor who did not put her patients first. I had an autoimmune response to a virus many years ago and basically, things in my body went haywire. Due the this I had many tests, visited a gastro doctor, a hemotologist/oncologist, a kidney specialist, etc. It was several months of problems and tests. This doctor (an internist the gastro doc referred me to) told me it was all in my head. My gastro doc about blew a gasket and felt so bad about recommending her. He about tore her a new one. He then gave me 3 names of internists and told me to choose one. He could not/would not recommend another name after what had happened with his first referral. I love the doc we have now. He was so thorough when I was going through all that and if it was something he did not know - he would tell me that and tell me how he was going to find out. I had a very weird thing going on with my blood and low grade infection in my urinary tract, along with colitis - all my body's response to the virus. Scary times, but I was so glad to have my doctor!!

I know nothing about kickbacks by doctor's, but I do know when my doctor wants me to try a new drug, it's really nice to get a free sample so I don't end up wasting my money on a drug that doesn't work or doesn't agree with me. I have a few hundred dollars in the trash from that happening in the past.

Sorry if I hurt your feeling Lyn or Quilly....

Thanks Tina.

I can so related to your story having several rare/orphan disorders that MDs are told in Medical School they would never see a person like me..... I had probably had at least 50 doctors that said it was "all in my head"....than no doctor wanted to help make my life liveable for fear of killing me after my geneticist or hematologist lectured them on these disorders. Doctors would wrongly Dx me and my son with "anxiety" among other things because our normal resting heart rates are well over 100 ppm. One doctor even told my son (who was just a teenager) than mice with fast heart rates die young. I just stated lucky my son isn't a mouse.... an explained that the heart is muscle and people with HCTD muscles have to work harder to keep us from falling apart. It's not that these doctors are heartless they just are ignorant to rare disorders or conditions. They are just voicing their opinions on the knowledge they have. Sometimes it can kill.

I don't think it should be expected that every general practitioner be conversant with rare disorders, any more than any attorney should know the intricacies of all types of law practice, or any musician be able to play every piece.

What they Should Not be afraid to do, is say "I don't Know what is wrong with you, but I will try and refer you to someone who can figure it out." I have referred several patients because I either am not sure what I am looking at, how I would treat it, or Know how to treat it but know I would not be happy with the result I would get compared to someone I know who can do the procedure better. A couple of these patients were very happy that I said this, and a couple seemed shocked that I would admit that I don't know or can't do something. Like "then what good are you?".

Tex - what's an "orphan disorder"?

Pal - I'm forgetting what it is you do in the medical field?

tina

An orphan disease is defined as one, usually genetic, that affects less than 1:1500 (in the US); 1:2000 (European Union) and 1:2,500 (Japan).

It's usually genetic, but the symptoms may not reveal themselves for some time.

The term orphan is related to the "Orphan Drug Act" from the early 80s. This means that companies are given funding to do research and develop drugs for diseases that are so rare that the cost of research and development may actually be greater than any financial return it might give the company.

I am a periodontist, and I teach a basic pharmacology and local anesthesia course, I treat patients in both private practice and in a clinic for medically complex patients (primarily HIV, cardiovascular or hemotologic) and supervise and provide non surgical treatment to primarily public health patients in a teaching-clinic setting.I used to be a blinded examiner in patient based pharmaceutical and device research studies.

Much of the treatment in the medically complex clinic, and all of the teaching clinic treatment is free to the patient. So I treat a cross section of people from one or two that have their own jet all the way down to people who have no phone or permanent address. So when I sound like a bossy know-it-all when we get into cultural and socieconomic discussions, it is because I have a variety ot direct personal, if second-hand experience.

I got my design degree after my post-doc.

Well I was right in my thinking then!!! I was thinking both you and Texas Hottie were involved in the dental field. I couldn't remember for sure!!

I always enjoy your hands-on views!! Thanks for answering the orphan question.

tina

Sorry Palimpsest if I hurt your feelings. Just wish there were more doctors practicing like you.

I totally agree with what you have stated about rare/orphan disorders. However in my case I have grey sclera which all medical students are told can only mean 1 of 2 things. My geneticist was shocked that none of my other doctors ever noticed.

Oh, not at all, I was thinking that it is important for Dr.s to refer if they don't know. "It's in your head" is not a good answer to give to a patient just because you don't recognize as a Dr. what the condition is. (Beside the fact that auto somatic and placebo are both recognized..."in the patient's head" can be very real to the patient, too)

Slight highjack on a question for those in the medical field!

Have you come across insurance companies that seem to favor allowing the patient one particular drug for a same ailment over another? Example: I have a sleep disorder where I do not reach a deep sleep usually until around about 5:00 or 5:30 in the morning. I do sleep but it's a light sleep that leaves me unrested the next day. I have had this whole life. My insurance company puts up the biggest fuss over allowing me Lunesta which gives me a marked better quality of life. My doctors usually get fed up with me and lunesta because the office has to spend so much time writing and jumping hoops. The insurance company will however allow Ambian in a heart beat. Ambian is additive, I hate it because it feels druggy and I always become wide awake in the middle of the night, I have no side effects from the Lunesta at all and it feels natural (insurance company knows this). My concentration and memory are greatly improved with proper rest from lunesta. Also, with proper sleep I can deal with the arthritis and bone issues without taking nightime pain killers which I also hate.

So what gives with that? Do insurance companies get kick backs from pharmaceuticals?
Why are they more than happy to allow a whole slew of drugs for me when I can get by mostly with one?

Ambien brand is cheaper than Lunesta and there is also a generic for Ambien.

There is no generic for Lunesta yet (although some internet sites sell "generic" Lunesta, there isn't one yet, 2012 is the earliest one could come out but it may not, this year.

It's all about saving money for the Insurance company.

There are also drugs that are not in the Insurance company's formulary, so they won't cover it at all.

It's a crazy world Pal, the insurance company wants to save money with ambien but would have no problem with a variety of pain killers and nerve blocks and specialty pain clinic fees and physical therapy and the list goes on. If I allowed it I would be a walking drugged up mess. But no, all I want is sleep and tiny tiny Lunesta sleep pill. What is wrong with those insurance people? It costs a zillion times more their way.

Just like nothing preventive in my field is covered.

I am also battling with the insurance company to get a systemic medication that alters collagen metabolism covered by a patient's plan. (It's not even that expensive). I was told that a mouth wash was "therapeutically equivalent". Snort.

Dealing with insurance companies is frustrating for both patients and physicians. Just think about it---- the physician prescribes the specific medicine which he / she decides is most appropriate for a particular patient. The insurance company denies it. The physician must then call to appeal the decision. In most cases the doctor speaks with someone in a clerical position. All too often the insurance rep just doesn't have the necessary medical knowledge to make an informed decision and again rejects the drug.

Then the physician has to request a review by a supervisor. Many times this is fruitless and the next step is to request a review by one of the few medical doctors employed by the insurance company. In my husband's specialty (hematology/oncology) he has yet to speak with an insurance company physician who has enough medical training or experience to comprehend the complexity of the diagnosis and the need for this particular drug.

Sad to say this is happening more often. Pal's post is another example. With all his years of training and experience in his specialty he has to try to explain to an insurance rep why a mouthwash is just not going to benefit his patient.

My insurance company denied my daughter's yearly hearing screen today, and she has a history of hearing loss, because it was not medically necessary.

If I could have only jumped through the phone.

Texask - you do not know what you are talking about.

I am a physician. I have never - never received a payoff for any drug, nor do I know any physician that has. I fight every day for patients and the drugs I feel are appropriate and testing I feel they need. I am almost worn thin fighting for my patients.

I hate that people like you think I can be bought off for a pen or prescription pad. My morals are not nearly as low as you would like to think. If you know you could be bought off so cheaply, I feel sorry for you.

http://content.healthaffairs.org/content/24/4/949.full

Think what you want. Physicians will soon be obsolete and you can enjoy health care by some internet trained nurse practitioner in the near future. Physicians are bad. Good luck without us.

We physicians as a group are getting pretty worn out with the blame game. Look to the insurance companies and illegal immigration for the ills of the health industry today. It is the physician getting the bad rap.

Primary care physicians eek out a living and have very little respect anymore, very little appreciation for the lives we have given up and devoted to our patients.

I also have a genetic disease that was not diagnosed until very late in life. It has reeked havoc on my body. I suffer effects everyday. It is a disease I was taught In medical school that I would never see in my practice. Do you suppose that I just failed to diagnose that disease in myself in others in my family for years for some subversive reason? Do you suppose that I am happy that my mother and my uncle both died of the disease before it was diagnosed?

The practice of medicine is not perfect, but to accuse doctors as a group to be uncaring and unethical is not to give credit to a mostly sincere group of people that have sacrificed more than you can imagine to do the best they can for you.

I thank God every day that I am the age I am. I don't have to work anymore. I went into medicine for all the right reasons, I will leave it with a broken heart due to people like you.

My patients know who I am and how I care for them. They are the only reason I keep going to work.

Go back and reread what I said White.... Drug reps do hand out "goodies" so they can get in a doctor door .... Nothing wrong with that.

I think I asked you for the piece of legislation you stated that made it illegal!

I never said most doctors were heartless just ignorant ...... unless a person has a textbook case or a disorder that was common. However in my case... Doctors were all taught in medical school what grey sclera mean .... So if you happened to be one of my doctors you failed me and my family (according to my Geneticist). Like Pal said they should have stated they didn't know what was wrong. However to say it was nothing was wrong. And I have lost far too many family members way to young due directly to doctors and, of course, genetic mutations (not insurance people or drug reps). Not because they were heartless but because of their ignorance.

White .... If you accepted a pen, pad, free drug samples, or any "goodies" than you accepted a "kickback". In the medical profession it is not illegal.

Only you would know if that "goodie" or "kickback" influenced your decision to Rx a certain drug. And probably the reason for it not being legislative. (Doctors policing themselves). Again I see nothing wrong with these "office supplies", "kickbacks", "goodies", or whatever you choose to call them (you used "payoff").

So White you blame the insurance companies and illegals for the ills in the health industry. Maybe you are correct but just maybe it's the healthcare industry itself. Doctors are now specializing (more $$$$); perhaps another reason for shortage of family doctors and internists.

Here's an observation.

There are a lot of ignorant statements that have been made in this thread.

None of which have been made by any posters who are physicians or closely related to them.

To state all physicians are ignorant b/c they failed to diagnose a very poorly understood genetic disease is an ignorant statement in itself.

Just as ignorant as saying docs are getting kickbacks of pens and notepads so they switch patient's medications around for new pens.

I've said my peace. Your health is in your hands and if you mistrust doctors and call them all ignorant, I wish you well finding one who will help you with your orphan disorder or diabetes or whatever illness you may find yourself having in the future.

White .... If you accepted a pen, pad, free drug samples, or any "goodies" than you accepted a "kickback". In the medical profession it is not illegal.

Only you would know if that "goodie" or "kickback" influenced your decision to Rx a certain drug. And probably the reason for it not being legislative. (Doctors policing themselves). Again I see nothing wrong with these "office supplies", "kickbacks", "goodies", or whatever you choose to call them (you used "payoff").

So White you blame the insurance companies and illegals for the ills in the health industry. Maybe you are correct but just maybe it's the healthcare industry itself. Doctors are now specializing (more $$$$); perhaps another reason for shortage of family doctors and internists.

Ignorance means the lack of knowledge. So Polly what word would you use instead?

Polly that is your opinion.... My opinion is that several posters, even yourself, can not seem to understand that those office supplies are considered kickbacks. Only the doctor would know if it's influencing his/her. By stating it's just pens seems to imply physicians would be easier influenced with office supplies that were more expensive.

For the record I didn't call all doctors ignorant only the ones that use the "all in your head" diagnose. I love my genetist and Maryland's hematologist. Of course, they are both smart enough to know what grey sclera mean. If you had a child or children with an orphan disorder or even a common disorder but with uncommon symptoms you could better understand what it feels like to be told one day nothing is wrong with your child ...... Or even worst you the Mom have Munchausen by Proxy because you know something is really wrong.... And than the next day you are told their lifespan is going to be short. Oh there is no cure so have them take massive doses of Vitamin C.

You would better understand when you just don't have to battle with insurance companies but battle doctors ..... So until you fought battles with many of doctors I could careless about your opinion. Battles with those insurance companies are a million times easier than battling with doctors. (money vs life).

And just like I said earlier......bad doctors dismiss their patients instead of listening to them. You may have seen a bad doctor, but it is up to you as the patient to seek out a physician that will listen and have a vested interest in your health and well being.

My point is you can consider the pens and notepads and occasional lunch a "kickback" or whatever you'd like.

It's ignorant to think a doc will actually prescribe it because they got the little kickback.

And actually, many years ago I had a doctor dismiss me when I was complaining of knee pain. Months of pain and multiple visits to the docs office and I was given a bogus diagnosis. You know what my knee pain turned out to be? A one in a million bone tumor that docs may never, ever see in their entire practice. Was he ignorant? I don't think so. But he didn't actually listen to all of my symptoms. Perhaps if he did, I wouldn't have had 7 more surgeries and prosthetic parts. But what is done is done.
If I continued to mistrust all docs, I may not be here today or be able to walk and be a mother to my children, and have the quality of life I have because a wonderful doc did have a vested interest in me and my well being and quality of life.

My observation is simply that the statements you make are ignorant. I'm sure many here would agree.

Perhaps David's story would give some of you (in the medical field) a much needed understanding.

www.ehlersdanlosnetwork.org/David.html

While I have seen some arrogant doctors with God complexes, I am so grateful that most of them chose their professions. I've read that their IQs average 140. It would have been much more profitable (and easier) for them to get an MBA from Harvard and make a ton more money. Their vacation time is much less than most and their sleep is constantly interrupted. For the life of me, I can't understand why anyone would choose that job. Maybe they actually want to help people. A pen?? Please.

Here's the definition of kickback: a percentage of income given to a person in a position of power or influence as payment for having made the income possible: usually considered improper or unethical.

In other words, if a doctor managed to prescribe a drug enough so that a pharmaceutical company made $100,000 profit, the company would then give the doctor some of the $100,000 as a "reward" for making them so much money.

Trust me, there really isn't a way for pharma companies to track that information.

I think what people here are referring to is pharma companies *bribing* doctors to prescribe drugs. The definition of a bribe: money or favor given or promised in order to influence the judgment or conduct of a person in a position of trust.

Those pens and pads of paper and the odd lunch aren't bribes--it just isn't worth that much. Those pens and pads of paper are promotional materials--my bank hands out pens, my hair salon hands out pens. Are you taking a bribe when you receive or use a pen with your bank's name stamped on it?

My sister-in-law is a doctor. She's in family practice. She spends at least one week every year taking continuing education courses in order to stay current in her field. She spends more time at home, reading medical journals and doing other research to help her patients.

Her first child was born with multiple birth defects--dislocated joints, really messed up vertebra that caused a spinal cord injury which resulted in quadriplegia, floppy trachea requiring a trach and a ventilator. At birth, they gave him less than 24 hours to live, based on everything that was wrong.

My nephew spent his first six months in NICU at the area's best hospital. His doctors, and my SIL knew who the best doctors were, could not figure out what the problem was. They treated the symptoms because that was all they could do. They were calling colleagues all over the country, trying to figure out what was wrong.

A new doctor was recommended to them. When he saw the MRIs and CT scans and X-rays, he had the courage to tell them he couldn't help my nephew. But he referred them to yet another doctor, 500 miles away, at a major Children's Hospital in another state. Just before his second birthday, they got a diagnosis of the syndrome that Nephew was, and a plan of attack on how to treat the 13 different birth defects that he was born with.

It's a rare disorder. And Nephew has some of the more rare symptoms and is missing one of the most common. There are many, many rare disorders and it is not possible for doctors to know them all. But it is possible for them to seek out help in finding out what a patient has. It can take a long time, though, until you find a doctor who can lead you to another doctor who has the knowledge you are seeking.

This has certainly become a heated discussion.

I'm not a doctor basher, but I'm also not particularly a doctor worshiper. With respect to the long years of school, the grueling hours of work etc...it is a job that one chooses, and it is overall an EXTREMELY lucrative profession. Here is a snip from the US Bureau of Labor Statistics Occupational Outlook Handbook, re. physician salaries:

"Earnings of physicians and surgeons are among the highest of any occupation. According to the Medical Group Management Association's Physician Compensation and Production Survey, median total compensation for physicians varied by their type of practice. In 2008, physicians practicing primary care had total median annual compensation of $186,044, and physicians practicing in medical specialties earned total median annual compensation of $339,738."

So, doctors certainly work hard and certainly most are dedicated healers. But let's not kid ourselves, doctors and their families live exceedingly comfortable lives because of the profession.

IMO if a doctor wants to have a nice dinner out or some pens it's certainly reasonable to assume s/he can buy that stuff for him/herself.

As for those grueling continuing education courses, many doctors find some dandy spots to keep their accredition current. They go to ski and beach and golf resorts.

So, no I'm not terribly moved by the plight of the physician in today's United States. They are amply compensated in many, many ways.

I'm not trying to stat something here but is the salary listed clear after paying the high insurance rates for malpractice and all the very expensive equipment and the high cost of rents and all else involved with running a business in the medical field?
There are good and bad in the medical field just like any other profession. It took me a long time with shopping around to find the right fit with the doctors I have now, I went through some horrible ones but really really like the ones I have at this time. Once I got the hang of keeping all my own records and always getting copies of test results things have been a lot better. I keep a great big file and always take it with me on appointments. I don't always take it in though but I do have it available. I also take prescriptions home and read up on the meds before I have them filled. This came in real handy recently with my husband where he was prescribed a drug that was not meant to go with another he is taking. You have to take an active role in your care these days because unfortunately a lot of doctors are just too busy.