Student Case: It Ain't the Cedar Buddy!

[mdebord]

For what it's worth, I think the steroid shots we give are something like $18 - not a booming profit and I'm not sure if I should take the implication personally or not.

 

When I first started at my job I was unfamiliar with the practice.  The patients were not.  About a month into my job the office manager came to me because so many patients had complained to her that I was turning them down when they asked!  I told her I would do some research and consider it.  I generally use them now in cases where inflammation is the problem (allergies that are not responding to OTC tx, asthma, bronchitis, etc).  I do not give them for URIs, which continues to be a sore spot between me, the patients, and the powers that be.  As for the nasal steroids, I love them and take them personally.  I cannot count the number of people who have refused to take them.  Y'all may be starting to get the picture that I seem to have an unusually high number of difficult patients who were used to getting what they wanted before I started working here.

 

It all goes back to a similar argument in a different thread: In a world that includes patient satisfaction surveys and pressure from employers, we are not always free to practice the best evidence-based medicine.  I do what I can and I win people over sometimes.  I also lose patients who will just go somewhere else and get what they want.  There tends to be a lot of negativity and judging on this forum; I would just ask everyone to remember that we are not always familiar with the circumstances that others are operating within.  Be kind.  

[EMEDPA]

18 bucks would be a great price. at my place I think it would run well over a hundred because they bill separately for drug, supplies, and administration.

IV meds are even worse: 100 bucks to start the IV (includes supplies), 100 bucks per bag of fluid, 100 bucks for each IV push med given(NOT including the price of the med...).

an IV, a bag of fluid, and a few meds for migraine for example runs well over 800 bucks with the exam fee.

[GetMeOuttaThisMess]

mdebord, no comment that I've made was intended to be directed at you specifically so please accept my apology if implied otherwise. My response was dictated by the fact that there are practices that can increase their profit margins that provide a medication that isn't any more effective than a cheap prescription, and is not without associated risks. Worst thing that happens with a tablet is they choke, cough it up, and swallow it again. Speaking for myself only, I do carry some negativity because I see medicine being practiced in a manner that hasn't been documented in my mind to be any more effective than cheaper, less expensive options for the patient. Last time I checked we were supposed to be doing this for the patient's benefit, and not the provider/group. This is one of the primary reasons why I walked away from my last position. If I can't do what I believe is the right thing for the patient then get someone else. Case in point. One of my former peers went to work for a low-income practice and regardless of their presenting c/o, ALL got IM Rocephin and IM Decadron. Same thing goes for every Tom, Dick, and Harry that gets a Z-Pak for a cold. I fully understand that the patients get upset but that is also part of the job, and no, I rarely win the discussion by convincing them otherwise, but I still know that I first did no harm by declining to write the script.