* * Anonymous Doc

Wednesday, March 16, 2011

Patient's daughter: "Can we give my mother [other drug] instead of [drug she's on]? I used to be a drug rep for [other drug]."

What in the world is the correct answer to a patient's daughter asking if we can switch her mother's medication because she used to be a drug rep for a competing pill?

I mean, besides, "no."

Or, "actually, we make drug decisions based on the drug we-- your mother's doctors-- think will be most effective, not based on who manufactures the drug, because, frankly, I don't even know the trade names of most of the stuff we provide, and who makes it, and don't care."

Drug reps get a hugely bad rap, and I really can't speak with any expertise about them, because they're banned and we never see them, they're a non-factor for residents. But for a patient's daughter to think that having been a drug rep for a certain drug is a reason why we might switch her mother's medication-- that's bizarre to me, and a completely off the wall request.

Not that we don't get off the wall requests all the time. "Can you do that later? We're currently visiting," is a common one. I understand it, sort of-- you come to visit your family member, and, sure, it sucks if a doctor comes in to wheel him away for a test. But they're here for tests, they're here to hopefully get better, and there's no way we can coordinate a schedule around the visitation of family members. He needs an MRI, the MRI is available, he's getting the MRI, even if his twelve kids just flew in from Antarctica to visit. He'll be back, don't worry. He'll be here all night. But the MRI technician won't be, and that's the priority. And yet people act like we're being horrible if we insist on getting the patient to the test. Or if we insist on interrupting the family visit to take blood, or give medication. Guess what? If you stop arguing about it, it'll take two minutes.

Okay, this post sounds angry and I don't mean it to sound angry. It's just frustrating to have to keep explaining to people that what we're doing is important, needs to be done, and will make their family member better (we hope). We're doing it for their benefit, not ours. And it's so hard to get the MRI scheduled-- too hard, absolutely, and I don't entirely understand why it has to be as hard to manage these schedules as it is-- and I don't want to lose the day, nothing good can happen from being pushed to the next day and having to start the process all over again, for any of these things. And it's hard when families don't understand, even though I sympathize with them wanting to see their family member, and not having all day to visit, and traveling distances and being squeezed by their real lives. But at the end of the day, I have to believe that they would rather their visit be cut short and their family member get better than they get all the time in the world to visit a dead person. That sounds harsh, and it is, and I don't mean it to. And of course it is better for family members to visit than not visit, and we shouldn't make it harder than it needs to be for them to visit and get to spend time with their family member. It's just hard to balance 15 patients, their families, the specialists we're dealing with for each of them, and the techs actually doing all of the tests, that's all.

But, regardless, no, being a former drug rep for a competing drug to the one your mother is on is not a reason for us to switch drugs. Sorry.


  1. I don't think you are being harsh at all. You are being realistic and just trying to do your job to the best of your abilities. You empathize with the patient and with the family members; you understand their motivations and why they get annoyed when you interrupt.

    You can't do anything beyond: explaining that you understand that the timing of treatment can be a nuisance, showing appreciation that they are providing support for their patients, and explaining that treatment is the priority.

  2. The drug thing... that daughter is nuts.

    Testing... maybe things are different where you are. I had a nurse come take my newborn because they wanted to run a quick test. 45 minutes later my husband went to see what was taking so long and discovered that they'd just parked the bassinett in the nursery and wouldn't be doing the test for quite some time yet. He said, "Come get me and the baby when you're actually ready to do the test." Ever since then, I've been skeptical about claims of the need for a test to be done at a specific time.

  3. Try telling the daughter that [other drug] isn't on the hospital formulary and watch her writhe in agony. Good times.

  4. To me, if a customer says, "Can I switch to a different drug, I trust Drug Company X more than Drug Company Y," that's not unreasonable. I can think of a lot of reasons you would say no, such as the drug being different in a relevant way, your not being sure whether the drug is different in a relevant way, or cost concerns, but my default response would be a "Yes" or maybe "Yes, but I get to say 'I told you so.'"

  5. Why would you think it is nuts for someone who has professional expertise to ask for the drug she knows about? I don't understand your objection.

    Now, if she'd said she wanted the change because she owned stock in one company I'd think she was off base, but drug reps do at least read the materials they work with. I'm with the daughter on this one.

    - KrisW