Make up your mind, you freaking quack doctor!

The BBQ Pit
1

My left eye has been sore and tender for the past couple of weeks. My allergies are up and running wild, so I attributed it to that and thought I’d keep up with the Allegra and Flonase and hang in there until we get a hard freeze and all the pollen dies down. Yesterday, after thinking about it, I got a bit concerned that it wasn’t going away–no better, no worse, but still there–so I called my eye doctor. My doctor wasn’t in, but they worked me in with his partner (who I’d not seen before).

The doctor comes in, give my eye a quick look (literally, this took approximately 3 minutes from the time he walked into the exam room, until he walked out), diagnoses me with a “mild” bacterial infection in my eye, and gave me a prescription for eye drops and tells me to use an over the counter eye drop for lubrication, that my eyes are dry. No tests other than visually looking at my eye.

On the way home, I call Hallgirl1 (who is a pharmacy tech) to find out how much my drops are going to cost. $136 freaking dollars. (No generic is available.) With my insurance, it comes down to about $75. Seriously. I’m having sticker shock in the car, so Hallgirl1 talks to her boss (the pharmacist) and he recommends two other drops to treat bacterial infections of the eye, both of which have a generic available and both of which will run me (after insurance) under $10.

So, I call the eye doctor’s office to get a less expensive medication (they’ve gone for the day) and this morning, I get a call back. According to the eye nurse, there isn’t another medication to treat my infection. (Really? No other medication to treat a bacterial infection of the eye?) This $136 medication is THE ONLY ONE. The others are not the same (but very similiar, the pharmacist has told me–both will work for bacterial infections) and will NOT TREAT MY EYE INFECTION. Instead, through the eye doctor, the eye nurse tells me that the infection “appeared to have almost run it’s course” so the OD recommends that I use the over the counter drops only, unless it gets worse, then I’ll have the get the prescription filled (for $136).

Now, I find it odd that while the pharmacist (whose job it is to know what medications will do what) tells me that there are other drugs on the market to treat my infection (and have been on the market long enough to have their patents run out so they can be produced on the generic market), but the OD won’t prescribe the less cost drug, even though I’ve explained that the most expensive drug is out of my price range and I’m unable to get it due to the cost. Also, while my infection was bad enough yesterday to prescribe medication, and including OTC drops, today my infection isn’t bad enough to warrant medication?

It seriously pisses me off that not only will he not even consider the cost of the medication for his patients, but he’s completely unwilling to even consider another (less expensive) medication and he can’t make up his mind if it’s needed or not!

I’m thinking of filing a complaint, but not sure where or with who. At the very least, I’ll be writing a letter to his partner (my usual eye doctor).

2

Oh, yeah, definitely write that letter of complaint!

I, for one, am bloody sick and tired of docs who don’t consider the bottom dollar for their patients. Fortunately, we now have prescription insurance that pays for a lot, but I remember one time, before we had that insurance: I was seen for a doc in the ER about a kidney infection (as you may or may not know from previous threads, they’re frequent with me), and hubby went to the pharmacy to get the 'script filled. The prescribing doc paid no attention whatsoever that we didn’t have insurance. He wrote me a 'script for Levaquin, which hubby would have had to pay $130.00 to fill. :o He called the ER back and said “I can’t afford this” and the same doc wrote a 'script for a sulfa drug: under $4.00. :rolleyes:

3

Gosh, the doctor wouldn’t prescribe the drug you wanted them to, even after you explained that you can’t afford the one that they did prescribe? It’s almost as if the doctor lives in some crazy, backwards world where the proper treatment is not always the cheapest or most convenient.

4

Unless they took a culture, and did sensitivities showing resistance to the medications in the ‘other’ eye antibiotics, I’d be hard pressed to think of a reason that only one specific type of eye drop would work.

And IAAD who prescribes eye medications. And who works closely with optometrists and opthalmologists for my problem patients.

5

While reading the post I had two thoughts.

  1. The nurse was too lazy to actually check with the doctor or he wasn’t there and just wanted to get rid of you.

  2. The doctor has seen the same looking problem with other patients and this is the only medication that has been effective through trial and error.

Although I am usually more inclined to be on the medical professionals side, I choose #1.

6

I am not shy about saying, “I don’t have prescription coverage. If you’ve got samples, I’d love them. If there’s something inexpensive that will probably work, even if it’s not BigNameDrug, please prescribe that one for me. If BigNameDrug is truly the only thing, then so be it, but I know there are usually other options.”

I haven’t had any problems with this sort of approach. That doc was an ass.

7

I had a similar problem with contact lenses, but he started it by telling me they didn’t make the brand of contacts I’ve been wearing anymore, which proved not to be true. Then he said that they were “better”. I said I was perfectly satisfied with what I’d been wearing, and the others were much more expensive. He insisted on ordering a sample pair for the other type, which I duly tried and told him I did not like them. “But they’re better!”

Finally I talked one of the receptionists into just confirming the order for the type I’d been wearing regardless. Pain in the ass.

8

I was wondering about that myself. No swab? No culture? Just assuming bacterial infection, and assuming that one eye drop is the only one that would work on an unknown bacterial infection? Something doesn’t add up to me, either. I don’t know if it’s as bad in the world of eye infections, but doctors prescribing antibiotics without confirming bacterial infections is one of the reasons we have MRSA to worry about today. If it’s bad enough for a $136 eye drop, isn’t it bad enough for a swab and culture?

9

I’d hate to live in that place! I’m quite happy here, where given a choice between equally appropriate medications, some doctors concidentally prescribe the one hawked by the pharma rep offering the biggest breasts and the most schwag…

10

If you just need to vent; have at it.

If you want to post the prescribed med, one of us might take a shot at an opinion about how important that particular one is.

I will say that patients seldom get the facts right, which is not to say your doc isn’t a jerk. There are numerous inexpensive broad spectrum antibiotics for the eye, so the story doesn’t make sense to me.

We don’t typically culture routine conjunctivitis. Adds to the cost without much benefit and we don’t wait til cultures are back to start tx if we think it’s indicated.

11

One other thing…conjunctivitis is often viral or allergic. Are you sure you didn’t get an Rx for something like Patanol (or one of the other meds to treat conditions such as vernal keratoconjunctivits) instead of an antibiotic? I believe those meds do get a titchy bit pricey.

12

I will repeat this until it becomes a Public Mantra;

Professionals work for you.
If they don’t work for you, find another.

This applies to ALL professionals. Accountants, Plumbers, Doctors, Lawyers.

13

It’s not reasonable to expect even your regular doctor to know all the ins and outs of all their pts insurance, pharm coverage or lack thereof.

We don’t work for you, we work with you, a pt who is not an active participant in their health care is gonna meet with a lot of frustration. A simple ‘can I get a generic, my Rx coverage is kinda crappy.’

We get request from phamacists all the time to change Rx for billing sake, it’s no problem when options exist.

If the pharmacist didn’t talk to the doctor, all he can really tell you is that he has generic abx drops that are effective for the things your Rx is usually written for, he has no idea what the prescribing doctor is thinking if he doesn’t talk to him

14

Oh jeez…and I thought doctors were supposed to be smart

Didja ever think of asking? Really. Of course you can’t be expected to KNOW, but saying …this medication may be expensive, does your insurance cover prescriptions…is that really a hard question to remember to ASK? Your’re the paid professional and the patient is your client, YOU are supposed to run the meeting and see that the right questions are asked and answered so you prescribe a treatment that will not only be effective but one that the patient is physically, mentally and financially able to comply with.

I think it is perfectly reasonable to expect your doctor to discuss the cost of proposed treatments. My doctors have always asked about my insurance coverage before deciding what medications to prescribe. Sure, your patient may have not said "my insurance is kinda crappy, but the freak didn’t YOU ask "Is your insurance good???
In the rare cases when I have had to hit the pharmacy for a $100.00+ medication my doctor has prepared me for the cost and convinced me it’s money I need to spend. In most cases, there has been a cheaper alternative and sometimes that alternative has been nothing.

Any doctor who prescribes a treatment that the patient can’t afford without warning them of the costs has just wasted the patient’s time as well as theirs. The patient would have been just as well off not going to the doctor in the first place and would’ve saved the cost of a doctor’s visit.

The extraordinary cluelessness of most doctors is a continual source of amazement to me.

15

I’ve finally come to the understanding that doctors have a far different idea about what constitutes “expensive” than I do. I guess it’s because, in their world, they see people on meds that run into multiple hundreds of dollars every month, so one little $80 scrip really isn’t all that bad. At least, that’s the only reason I can come up with.

Now, instead of saying, “Nothing too expensive,” when they write out the prescription, I’m more specific, mentioning that, if possible, I need something I can get from the $4 list at Walmart, or something not much higher than that. And I tell them I need something that has a generic available. They can’t ALWAYS comply, but at least I’ve gotten far fewer shocks at the pharmacy checkout!

16

I got in the habit of keeping a copy of the navy availability list with me because I would prefer to get a med I can get free from the dispensary on base instead of one I need to pay for. I get my metformin in wonking huge bottles, they give it to me 3 months at a time=) and when I went to CVS they told me that midrin was no longer produced, but the navy pharm mate had no problem filling the scrip and told me the generic form was not being made, but the original was and CVS had a bad habit of not bothering to put themselves out and research what is actually available and telling people the drug is no longer produced…

17

I find this statement very interesting.

So not only is your healthcare professional supposed to know how to diagnose and treat your ailment, he is supposed to know the ins and outs of your insurance program and financial status?

Maybe he should follow the patient home and give the medication every four hours as well.

I’ll tell you what I find amazing. The amount of people that have absolutely no clue what their insurance plan covers, what their copay is or what their deductible is. They look at the medical staff expectantly for all this information. Insurance is a contract between you and your insurance company. If it is a managed care program, there does exist a contract between the insurance company and the doctor but it has nothing to do with walking you through your individual benefits.

There is nothing wrong with asking for a generic brand if possible but to expect your physician to know the cost of everything he feels necessary to prescribed is absurd and unreasonable.

18

Here’s the letter I wrote to my dr. this morning:

Dear Dr. M,

As my family and I are long time patients of yours for nearly 10 years, I called on Monday, November 10 when I became concerned about pain and irritation in my left eye. The woman with whom I spoke gave me an appointment the following day with Dr. E since you were not in the office. When I arrived for my appointment, I was told that it wasn’t on November 11, but November 26, however, Dr. E. agreed to see me. (I found it odd to have supposedly scheduled an appointment for two and a half weeks later for eye pain, and would not have agreed to it.)

Upon my brief exam by Dr. E, he stated I had a bacterial infection in my eye, gave me a prescription for Tobradex, plus a sample of Systane and the assistant gave me directions on their use. When I attempted to get the prescription filled, I was shocked to discover that it would cost over $130 to have it filled. (Even though I have prescription insurance, my cost was not too far removed from $130 and still more money than financially acceptable.) I spoke with the pharmacist, who explained that there were other medications to treat bacterial infections of the eyes, and in fact, there was one for which a generic was available that was very similar to Tobradex, but without steroids, and the cost was less than $10 out of pocket.

I called the office, requesting another medication and explained that the costs were too much. When my call was returned the following day, the woman with whom I spoke explained that Dr. E refused to provide an alternate prescription, that “Tobradex was the only one that would work”. I again explained that the cost was prohibitive, at which point, I was put on hold. When she returned to the line, she stated that Dr. E instructed that I should use the OTC drops, Systane, and if my eye got any worse, or did not get better within a week, then I would “have to get the original prescription filled”.

Having working in the nonprofit field in the past, I am aware of the great lengths that Your Eye Care Center has gone with its generosity in treating those in need, which leads me to believe that those at Your Eye Care Group are aware of the impacts finances can have with obtaining needed treatment. Therefore, I was very dismayed and surprised to find that my concerns in obtaining medication that was affordable for me were treated in such a callous manner. I was also confused as to why the resistance in receiving a prescription for another medication—surely bacterial infections in an eye have been treated prior to the relatively new release of Tobradex. I also had concern that while in the office, my condition warranted treatment, however, upon my phone call, this apparently had changed—and not because the medical situation itself had changed.

At this point, I am using the Systane as instructed, still incurring irritation and pain in my eye and hoping that it will get better soon, as I remain without the $130 to fill the prescription. However, I am now disappointed at the quality of care and follow up treatment I received from Dr. E and his staff. If not for the quality of care my family and I have received from Your Eye Care Group in the past, I would be searching for a new eye care group. As my primary optometrist, I felt you should be made aware of this situation.

Respectfully,
Phall0106

19

Word. I feel like I pissed away my $15 co-pay, an hour worth of my time and I still have a sore eye…

20

I have lots of routine allergy and sinus issues, and my family doc back home always had pharmaceutical samples on hand that he would give me (if he had them) instead of making my folks pay to have a prescription filled. We appreciated that. Unfortunately, that made me expect doctors to have “routine” medicines laying around their office to give away. Last time my sinuses closed up real bad and I absolutely had to have Flonase, it cost me $75. Ouch.