Saturday, May 12, 2007

Wake Up, Physicians: The Back Room Isn't Out of Sight Any More

The Tennessean (Nashville) had a forceful editorial last week, jumping off from the widely publicized study by Campbell et al. in the New England Journal (read about the NEJM study at

The editorial was pretty hard-hitting in condemning conflicts of interest that are destroying patient trust in physicians, but what especially caught my attention were the readers' comments posted on the website below the editorial. Here is a sampling:
The last three times I visited my doctor, Pharma Reps were setting up breakfast or lunch. Once while sitting in the waiting room, a Rep strolled in and asked the Receptionist if he could get "on the List" to provide breakfast or lunch to the office. She pulled out what I can only assume was an appointment log to keep track of lunch and breakfast appointments for the reps. She gave him a time and he happily went on his way. The office smelled of food all three times. I heard one of the staff say, "What's for lunch?" and another said I don't know but it smells like Mexican food. It appeared to be an everyday thing with this particular group. I stopped going in their office because I always came out with a handful of Rx that I didn't need.
I was recently at my doctor's office. A rep from a pharmaceutical company came in. He was ushered into the front office where he hooked his laptop up to one of the doctor's computers and did a download. After he finished, he thanked them and said, "I'll see you next month", then left. I am in the healthcare field myself and understand the pressures on health care providers to safeguard patient information. [HIPAA] has folks running scared. I had to wonder what kind of incentive would be strong enough to get my doctor to let someone walk in to his office and get unfettered access to one of his computers.
What most struck me about these postings was the way that I think my fellow physicians regard their relationships with drug reps. (I cannot document this with firm data.) It is my impression that physicians, over many years, have gotten used to thinking of what happens between them and the reps as occurring in the "back room." The giving of gifts, the providing of lavish lunches for the office staff, all supposedly happen out of sight of patients. The physician can have his cake (or his sandwich or his pizza) and eat it too. He gets all these freebies but never has to worry about patients seeing what is going on and asking embarrassing questions--or, worse, deciding that they can no longer trust this doc because he seems to be in bed with the industry.

Well, guys, wake up. There is no "back room" any more. All our shenanigans are now clearly visible to the patients. And an increasing number of them don't much like what they see. Check out the Tennessean editorial if you don't believe that.

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