Indonesia Anonymus

We are a group of Indonesians, ranting about our beloved country. This blog is a result of many people grumbling about many things in many ways.
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Anonymus is the Latin word for anonymous, the correct English spelling. The Latin spelling, however, is traditionally used by scholars in the humanities to refer to an ancient writer whose name is not known, or to a manuscript of their work. Read more at Wikipedia.

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Friday, August 18, 2006

Being (a) Patient

Do you trust your doctor? When your doctor gives you perscription, have you ever wondered if the medication is really for your benefit and for your benefit only?

D, one of our secretaries, started to wonder. A few days back she went to see a doctor. Had always been a very fit young lady, D doesn't really have a doctor that she can call her own, so she went to a clinic recommended by some of our colleagues. It's one of those where you can find a group of doctors both GP and specialists (in various fields) under one roof. You can either go there to see one particular doctor (if you already have one in mind), or if you have no preference, you can see whoever doctor is available at the time. It's quite a popular clinic. Almost everybody at our office know of it, so it should not be so bad.

Been busy at work (because of us. Sorry D!) she arrived at the clinic near closing time, so the clinic was not so busy, although some doctors still seemed to have longer queues than others.
Not knowing which doctor to choose, D picked one with the least queue. There was only one man waiting by the doctor's door.
D took a seat in a distance from the guy.

"Just one patient to go before my turn. That's not too bad.." thought D.

But this guy apparently was not a patient. He, noticing the presence of a young lady in the vicinity, started a small talk.

"Do you mind if I go in before you?" asked the man.
What a question. Men can be really silly when they wanted to start a conversation, thought D. But D replied anyway:
"Well, you are here before I am. It's only fair..."

"Ah yes. But I am not a patient. Some doctors would like to finish with their patients before they let sales-rep in..."

So he was. He was a sales representative of a pharmaceutical company, and was there plugging a new brand of drug.

D was a bit curious how a drug sales rep works, so she asked more about his job and the products he was carrying. Didn't want to miss the sole chance of sitting closer to D, our sales-rep pulled out some brochures, and started explaining stuff. D couldn't get most of it, but she was impressed with how well-prepared he was. He had everything. Research papers supporting the drug, all kind of brochures, including the tiny little brochures in a size of namecard, and lots and lots of freebies: notepad, sticky-pad, coasters, keychains. He even gave D a free pen. It's amazing considering what he was carrying with him was a slim suitcase and nothing else. He was like a magician pulling tricks out of a hat.

The doctor's door opened. One patient went out and our sales-rep rushed in. (With a few moment to spare to give D his namecard. Yes, with his cellphone number on it. Hey, can't blame a man for trying, right?).

To cut the story short, About ten minutes later, the door opened. Our sales-rep left and D went in.

D explained to the doctor about her problem, and the doctor listened, asked questions and then said he would give her a prescription to take care of the problem. It's not serious, nothing to worry about. Just take the medicine regularly and D will be fine.

So the doctor took a pen and started writing the prescription. And then - to D's amazement - pulled out a card from his pocket and started copying the name of the medicine from the card, to the prescription.

It was the same card-brochure our sales-rep showed D just 15 minutes ago !

D froze for a while. She could not believe her eyes. Now this was either a really-utterly-wildy-unbelievably-one-in-a-million-chance type of coincidence that the sales-rep's medicine matched to the health problem she is currently having, or... :
The doctor wrote that simply because he was persuaded by the sales-rep and it had nothing to do with her problem at all.

Naturally, D thought it was the latter. And that upset her. But she kept quiet and civil about it. Despite the urge to punch the doctor in the face, D kept her patience, listened to the doctor, took the prescription and left.

The prescription ended up in the trash bin at her home.
"There is no way on earth I will take the medicine," said D. "I just don't trust that doctor."

Now, before you get all freaked-out about this, or you doctors get all upset, please allow us to remind you that we have no intention of doing any smear campaign against doctors. This may well be (or at least we hope to be ) an isolated incident. So please, don't generalize. There are many good, honest, dedicated doctors out there.

But it is only normal if we believe that there is something going on here: something between pharmaceutical companies, doctors, and how the relationships influences drug-prescriptions.
And mind you, this is not something that only happens in Indonesia.

Read what we found out when we dig for more info relating to this issue: The international herald tribune wrote about what is going on in the US [1].

"Merck was happy to pay $258 to provide Chinese food to the 20 or more doctors and employees of a pulmonary practice so that its sales representatives could tout the virtues of an osteoporosis drug and an asthma treatment in a relaxed setting."
...
"Across the United States, such lunches are believed to cost the pharmaceutical industry hundreds of millions of dollars a year".
...
"The doctors always insist that they can't be bought. But a former sales representative for two drug companies said the lunches were "incredibly effective" in lifting the number of prescriptions from practices that received the free food..."



Poor D. Now she does not know where to go.

=====
Source:
[1] Please hold the free lunches - The International Herald Tribune - August 11, 2006, Page 6

16 Comments:

Blogger Ujang said...

I wonder if you have seen the April 2006 edition of the Atlantic Monthly. There was an excellent article by Carl Elliot on this very issue. If you're really interested, you should take a look at. The link : http://www.theatlantic.com/doc/200604/drug-reps
(subscription may be required).

Unfortunately, what D experienced happens more than you think. Most doctors may only get keychains and coasters, or even $258 worth of Chinese foods. But some (smaller number of cases of course) got more than that. How about a swimming pool in the backyard ($35,000) or $300,000 to peddle a drug in conferences? Some doctors are actually willing to sign on ghostwritten journal articles promoting certain drugs.

Let me put on my economist's hat and say that it's a classic example of what happen if the seller know more about the good than the buyr (the patient do). Strong code ethics in the profession help to prevent doctors to prescribe unnecessary medication or treatment. But the asymmetry of knowledge between you and your doctor always put you at a disadvantage.

Okay, now I have to write a disclaimer that I too, have no intention of doing any smear campaign against doctors. There are many good, honest, dedicated doctors out there. The vast majority of them are.

10:45 PM  
Blogger Indonesia Anonymus said...

Ujang,

Thank you for the information.
this is a bit disconcerting, isn't it?
You explained it well about the asymmetry of knowledge.

If the only safeguard against this is strong code ethics in the profession, it is probably not (scary) enough.
One say, the 'police' who watch whether code of ethics has been followed (or broken) by doctors, is the association of doctors.
Hmm... doctors watching other doctors?

3:34 PM  
Anonymous ryosaeba said...

i wast just reading about chiropractic when i realized that the current state of medicine has only started about a century ago, it was the start organized medicine.

9:56 AM  
Blogger santy said...

I do believe some of them get more than just keychains and coasters. I wonder what that doctor would say if only D had bluntly asked him about his action right there and then.

My apologies for going OOT here, but there's one thing I can never figure out. My dad's been ill for over 15 years now. We've been going to the same hospital just because his internist is there and all his files from years back are there as well. Everytime he needs to be hospitalized, we are expected to pay at least 8 million rupiah as a deposit. And the usual case is always 'oh, the 1st and 2nd class are full, we only have the VIP rooms.' (which of course cost a fortune!) Now, how am I supposed to say to that when my dad was lying helplessly in the emergency room? I say it's a total rip off!

I'm actually lucky to have a doctor in the family, who can help me through the treatments. He'll tell me if there's no need for another CT scan (which cost about 1 million rups per scanning) and he'll be able to suggest an alternative medicines which are less expensive than the one recommended by the hospital's doctor.

I can imagine myself without an expert help. I'd be totally confused as to go with whatever the doctor says or not.

It's funny how one day, I met an old friend of mine who's now working in the hospital's front desk. One guy told me the 2nd class room was full, and all of a sudden, just by chit chatting with my friend, one 2nd class room is magically available! Oh, what a funny coincidence!

I guess what I'm trying to say is that, even though I had to borrow some cash from friends and families, I was lucky enough to manage covering the bills. What in the world would happen to the unfortunate ones? Some might say, well they don't need to go to that hospital. Oh, sure. They can go to some cheap clinics, they'll do fine over there! Anyway, that really bothers me.

10:52 AM  
Blogger Indonesia Anonymus said...

Santy,

truly sorry about your Dad. Many of us here share how you feel.
Some shared the same experience as the one you had: "No other room available, only vip room... You can wait but it's not certain, but if you just take the vip room we can move the patient there right at this moment...."

It's pure business, in search of the highest margin.

When people at our office learned about D's experience (or read the blog), some offer a solution similar to yours:
Find a doctor who's part of the family.
They kindly offered a doctor who is their aunt, their brother, their niece.
That seems to be the way people take to bring back the trust.

As for the less-fortunate people you mentioned:
I was lucky enough to manage covering the bills. What in the world would happen to the unfortunate ones?,

Yes, that is the sad part, isn't it.

For sure spending so much time at a hospital taking care of your father, you have witnessed countless sad scenes at the emergency room or hospital lobby, involving people who can't afford the service.

We hope your father will get well very very soon.
We can offer nothing but our prayer: for your father and his health, and for you and your family, to always have the strength to go through this difficult time.

2:54 PM  
Blogger Jakartass said...

Some years back, having karate chopped a glass coffee table, I went to MMC in Jl. Rasuna Said for emergency sewing. I sat dripping blood on their pristine floor and waited as a fellow sufferer was dealt with.

Except he was out of it, in a coma or dead tired. Or dead. Anyway, his friend spoke to the newly arrived doctor who told him that his sick friend was in luck ~ a VIP room had just become available.

Five star service for five star patients?

I too am not impugning the integrity of most medical practitioners ~ my sister has been a nurse for nigh on forty years ~ but I do wonder about 'modern' medicine.

A profession in hock to financial viability will not provide the service a society needs. Such is the drive for profit that age old practices and arcane knowledge are in danger of being lost. And patients are in danger of becoming drug addicts.

Jamu anyone?

4:36 PM  
Blogger Indonesia Anonymus said...

Jakartass,

Your mentioning of jamu has reminded us of one colleague, who (that time) strongly believed that there is a conspiracy to 'kill' jamu.
You know, play down the effectiveness, exaggerate the side-effects, and so forth.
The point is to drive people away from jamu and embrace pharmaceutical products.

Unfortunately he couldn't proof it, and data was hard to come by, so we cannot write it...

7:30 PM  
Blogger roi said...

geeesss... I tought the absurdity of doctor only just wrong-diagnostic

+ doctor, I've got an headaches and i hardly cannot breath with my nose...and it always slimy
- well sonny, you've got a problem with your nose, maybe we should conduct a surgery to eliminate that problem. Don't worry, it just small surgery, it wont hurt you, we just only want to cut-off your nose..
+ ....

9:46 AM  
Anonymous Anonymous said...

The pharmaceutical industry is a multi million dollars business. They are profit oriented companies that obviously need to have profit orientation throughout their activitites. It is only natural that they have to strive to grow their companies against other competitors. Revenue, profitability, and growth should naturally be their goals.

(Indonesian) Doctors on the other hand, spent a fortune and endure continuous bone cracking effort to earn their degree. They may have to serve in reasonably undesirable areas or under some other more senior's roof for quite some time before being eligible for their own practice.

They too, are just mere human that have the right for future expectations and plans. They generally plan to raise a family. They have also standards, that need to comply with others of same profession.

It is a question of ethics or legallity, whereby if not clearly stated or defined in the beginning is going to be always ethical or even legal.

Maybe we are just seeing to many Hollywood movies about this honourable profession. Thus we set our expectations too high for the doctors to reach.

Perhaps, we can plan from now that for our children to be doctors as what we picture doctors should be, and see what comes out of it.

Meanwhile, again maybe, we'll just have to accept doctors as they are, for now.

4:41 PM  
Anonymous cherie said...

Weird.

For the patient's benefit and the patient's benefit only? Being a doctor is a job, and of course, a doctor needs money. Doctors work in a social matter, but it doesn't mean that they're social workers.

What if D really needs that drug to cure her disease? Why she didn't ask the doctor? Patients have rights to ask the doctor about everything the doctor will do to them. It's funny, just simply because D found out that the drug the doctor gave her was the same drug the detailer told her, she didn't believe the doctor. Well, she can ask for another brand if she wants, or she can even ask for the generic one.

I'm not saying that these are all D's fault, but she made a very wrong decision when she keeps quiet and blame the doctor without asking anything, and it's not fair for the doctor.

Well, just remember, when we become a patient, just ask the doctor about everything, the drug (why he gave us that drug, how will it work, is there another brand that's cheaper than this one, so on), the disease, etc. If we don't like the drugs, tell the doctor we don't like it. If he insists, then go and find another doctor. Don't shut your mouth and then blaming all doctors, or keep quiet then doing everyhing what the doctor said, be active and, use our rights to ASK.

By asking stuff to the doctor, we'll know whether he's honest or not, and we can prevent ourself (and our money) from a 'materialistic' doctors out there.

... and please pardon my english =)

2:43 PM  
Anonymous ryosaeba said...

you're asking for proof about down playing alternative medicine?

read discover's placebo vs placebo. found it via harry's blog.

my favorite quote:

After 10 weeks, subjects taking sham pills said their pain decreased an average of 1.50 points on the 10-point scale. After 8 weeks, those receiving fake acupuncture reported a drop of 2.64 points. In other words, not receiving acupuncture reduces pain more than not taking drugs.

6:54 PM  
Blogger Indonesia Anonymus said...

Ryosaeba,

Thank you for the link !
Very interesting !

7:18 PM  
Anonymous Anonymous said...

Have you seen the movie "Side Effects"? Your post goes perfectly with that movie. http://www.sideeffectsthemovie.com/home.shtml

4:44 PM  
Anonymous de2via said...

have you guys ever tried to go to puskesmas?

i've went to a puskesmas one time (from a friend's suggestion and to obtain a rest recommendation letter to be an excuse for absent from office's outbond to come to another office interview =D )
i've problem with my stomach and digestion - though i knew it's not really a problem and i did felt just fine

and... voila! for just Rp.2,000 you got to see a doctor (a nice lady, who knew my problem instantly just by hearing the first sentence of the symptom - 'masuk angin') - gave me a prescription and i should got the medicine through another window...

i guess it's not bad service for just Rp.2,000... since i knew for the same problem would cost me for nearly Rp.200,000 if i went to a nicer hospital nearby

unfortunately, i threw up after i took the green pill - with suspicious taste - we have to chew it. i then only took the one with commercial package (free to sell drug) and look familiar one.

i only took the pills once and then forgot that i was sick at the first place...

hehe...

that's why i guess we should really take good care of our self and appreciate our health

1:28 PM  
Blogger Harry said...

Just testifying about a doctor who's our family's friend. We knew him from the start - a poor doctor, very good man.

Several years later, he's a very rich man. Naturally, we feel very happy for him.

Until one day, when he openly bragged to us, how much money he's getting from his prescriptions. Seems like the pharma companies are able to link their sales to each doctor, and compensated the doctors accordingly.

It's probably the answer to a question we've had for some time now - why we kept on getting the most expensive medicines from him.

Needless to say, nowadays we try to avoid falling sick as best as we could.

To the honest doctors out there - we salute you, and hope you'll be generously compensated in many other ways.

5:17 PM  
Anonymous Anonymous said...

You know what? I think every person should be more responsible for him/herself. I always tell my doctor "it's my body, I decide what I should do about it."

In D's case, I agree with the comment that she should ask more information from the doctor to confirm whether she really need the medication or not. Nobody is pushing down the medicine down her throat anyway, and she can always get a second opinion if the case is serious enough.

It is a pity though that you can not take for granted and just trust other people whom you should be able to rely on.

And by the way, I find that the internet is a very very useful place to find more info and 'second opinion'. Read more before swallowing anyhing unknown to you. Cheers!!

6:40 AM  

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