Letters to the Editor - June 19, 2006

Drug reps could see prescriptions in this physician's name, but he couldn't - Doctors should rely on better business sense -- not government generosity

Drug reps could see prescriptions in this physician's name, but he couldn't

Regarding "AMA opt-out program will keep prescribing data from drug reps" (Article, May 22/29):

To illustrate how much more power drug reps and the pharmaceutical industry have than individual doctors, I recount an experience I had two years ago.

One day I received a call from a pharmacy, part of a national chain, to verify if I had written a prescription for a narcotic medication. On receiving its fax copy, there was no doubt left that someone was in possession of my prescription pad(s), and fraudulent prescriptions were being written. Since that particular prescription had not been filled yet, my wife -- also a physician -- rushed to the pharmacy to catch the culprit red-handed when he would show up at their drive-through window. She failed to apprehend him as the police would not come and wait with her but demanded that they be called only when the person actually comes to pick up the medication. He did come but took off when he was made to wait for too long -- the police took 13 minutes to show up.

What was most galling was that my subsequent request to the drug store chain to send me a list of all of my prescriptions for controlled substances that had been filled at their pharmacies for the last few years was denied.

It would violate the HIPAA laws, a bigwig from their headquarters explained. Obtaining a copy of my prescriptions on my patients will violate privacy laws while such data is on the fingertips of drug reps?

Since I have not received any invitations for dinners from drug companies who market brand-name narcotics, I console myself that not too many illicit prescriptions are getting written using my prescription pads and DEA number.

--Surendra Kelwala MD, Livonia, Mich.

Doctors should rely on better business sense -- not government generosity

Regarding "Medicare forecast renews call for pay reform" (Article, May 22/29): American Medical Association Chair Duane Cady, MD, calls on Congress to "tie Medicare physician payments to the cost of caring for seniors." Unfortunately, that paradigm, "cost-based charging" died in the United States sometime in the last century. We now live in an economy characterized by the converse, "charge-based costing." The days of passing on overhead to consumers ended long ago.

The marketplace, not producers, now determines the price of any product or service. It is incumbent upon physicians, and those who train them, to understand this distinction and thus be better prepared to survive in the era of declining reimbursement.

By applying the principles of operations management to clinical services, it is possible to redesign workflows, increase productivity and throughput and improve quality and revenue in the process.

Too many physicians are stuck in century-old workflows. Obtaining some business and management education will go a long way toward alleviating physician distress and will be much more effective than calling upon Congress to spend money it doesn't have.

--Michael A. Patmas, MD, Bend, Ore.

Editor's note: Dr. Patmas is the AMA House of Delegates alternate delegate from the American College of Physician Executives.