Lack of Customer Service in the USA

[N80]

I believe what started this line of the post was my comment about letting people have access to more classes of medications at the pharmacy without seeing a pharmacist first. We obviously have a different opinion about that.

No, as JD said, we probably don't. I think it is better for patients not to be able to aquire such medications without some sort of professional oversight. I already see enough people hurt themselves with over the counter medicines and 'natural' products as it is. But make no mistake, if you opened the pharmacies today, my business would double, not diminish. And again, this is not a doctor issue. I/we have nothing to do with it. Its all Uncle Sam.

 

[gemini5362]

No, as JD said, we probably don't. I think it is better for patients not to be able to aquire such medications without some sort of professional oversight. I already see enough people hurt themselves with over the counter medicines and 'natural' products as it is. But make no mistake, if you opened the pharmacies today, my business would double, not diminish. And again, this is not a doctor issue. I/we have nothing to do with it. Its all Uncle Sam.

So If I understand you right the two of you think that it is better for the hundreds of thousands of people in this country who do not have health insurance and cannot afford to go to the doctor to do without medications than it is for pharmacies to be allowed to sell antibiotics and certain drugs over the counter? Possibly if they did not have to pay the doctors fee on top of the cost of medication more people could afford medications.

 

[jdbower]

So If I understand you right the two of you think that it is better for the hundreds of thousands of people in this country who do not have health insurance and cannot afford to go to the doctor to do without medications than it is for pharmacies to be allowed to sell antibiotics and certain drugs over the counter?

It's not quite that simple. First of all, if you can't afford medical care you should look into Medicaid and/or free clinics. Second, the cost of the doctor's visit will likely pay for itself in the number of people who buy the wrong medication - just because the symptoms are the same doesn't mean the disease is the same. Finally, the lives saved passively by allowing doctors to monitor the community for drug resistant varieties is priceless. It's a tradeoff, you're increasing the cost of health care a little but you're increasing overall health quality by a lot.

 

[N80]

So If I understand you right the two of you think that it is better for the hundreds of thousands of people in this country who do not have health insurance and cannot afford to go to the doctor to do without medications than it is for pharmacies to be allowed to sell antibiotics and certain drugs over the counter? Possibly if they did not have to pay the doctors fee on top of the cost of medication more people could afford medications.

I'm not sure what to say that I haven't already said, but yes, in the interest of public health...in other words, in the interest of the fewest people being harmed, I think it is best that many medicines, most importantly antibiotics, remain prescription only.

And you yourself use the words 'certain drugs'. If you think it would be a better world if people could get medicine without a visit to a doctor then why not ALL medicine? Narcotics, antipsychotics, chemo, anti-arhythmics, stimulants, anti-coagulants. Do those sound to scary? Why? So if even you think only certain drugs should be prescription then who decides which ones? You? Me?

And your continued reference to antibiotics is pretty clear evidence to me that antibiotics in particular need to remain prescription only. You clearly don't understand, or don't want to understand the implications of inappropriate use of antibiotics for yourself or the population at large. There hasn't been a significant develop in anti-bacterial therapy in years and strains of bacteria like MRSA are getting harder and harder to treat. Inappropriate use of antibiotics is the cause. The level of inappropriate use would skyrocket if antibiotics could be obtained by people, like yourself (and most everyone else) who have no clue what they are doing.

In addition to that, how would the average citizen know that 10% of people who have anaphylaxis with penicillin could also have anaphylaxis with cefdinir? How many people would have to die making that mistake before some genius decided maybe everyone shouldn't have access to antibiotics? Would you recognize the symptoms of Stephens-Johnson syndrome, or erythema nodosum resulting from certain classes of antibiotics? Would you know which flouroquinalones would interfere with your Coumadin levels or shorten your Q-T interval in combination with other medications?

All of that is not to sound smart, its all common stuff to physicians, but it isn't common stuff, or even manageable to non-medical personnel, its to point out that a cough or a sore throat does not equal an antibiotic and that there is a big difference between an antibiotic and a Hall's mentholyptus.

In short, yes.

 

[gemini5362]

While some equipment like X-Ray machines could be paid for through procedure charges, I doubt you've been charged directly for use of the exam table or the sterilization equipment. Plus some equipment can't reasonably be paid for by the people who use it - if there are too few people in need of dialysis in a region the hospital may not be able to charge enough for the procedure (at least in good conscience) and has to amortize the cost over the other patients somehow (whether it's a direct billing increase, increased taxes, or reducing the doctor's salary so you don't attract the cream of the crop anymore).

Lets compare your post with another profession. Automobile Mechanic. Some of their specialty machines are charged directly such as front end alignment machines and computerized engine analyzers. When those are used on your car there is a fee for that particular machines use. The wrenches and screwdrives that a mechanic uses are not a specialty fee and are included in the overall bill for your repairs. I expect the exam tables and sterilization equipment would fall into that catergory.

But the point is that looking at what the insurance company pays and trying to deduce what a doctor makes is irrelevant, it's like going to the grocery store to get the price of corn and then counting the ears in a farmer's field to figure out how much he makes, ignoring the cost of the seed, fertilizer, tractors, etc. In your case at $100 a pop the ear of corn you've sampled is from an upscale organic market, typically doctors get paid from the cardboard bin at the end of the Walmart aisle.

I took the amount of patients that he said he saw in a day and multiplied that times what I have seen doctors traditionally charge in my area. I have trouble believing that my doctors charges of 100.00 per visit are the high end of the price scale. I believe that when I saw a neurosurgeon his 350.00 for a consultation was more the upscale organice market. I would have to be shown numbers to see a physician in the united states that typically charges what you seem to be calling the cardboard bin at the end of the walmart aisle fees. ( I assume you are saying that they are considerably less than 100.00 a visit.) I showed your comments about the 100.00 a pop ear of corn being the upscale organic market typical fees being more toward the cardboard bin at the end of the Walmart aisle to an attorney I know. I know for a fact that this attorney used to represent doctors in contract negotiations and draw up leases for doctors clinics. When I showed the attorney your post they burst out laughing. They thought it was hilarious that you feel 100.00 per visit was the high end of the scale.



Actually George stated that it's his belief (and one that I share) that improper use of medications like this will INCREASE his business and may be one of the reasons why a lot of socialized health care countries have so many issues - if something's free and easy to obtain it's not treated with the respect it deserves.

You and George are very entitled to your beliefs. I am of the belief from some of the reading I have done that one of the bigger problems with medication is that someone either does not finish their medication when they start feeling better and that allows the disease to return in form that is more resistant to the drug it was being treated with.

Ironically, as you've phrased this (and I'm willing to assuming it's a phrasing issue) is the root cause of the lack of customer service in the USA (not to derail the conversation back to the original track ). It shouldn't be that a service should want people to be forced to use them, a service needs to carve out a niche that makes the extra money required worthwhile. I've dealt with realtors who were awful, I had to bring a list of properties from realtor.com myself because they wouldn't listen to what I wanted (or were too incompetent to figure out the search) and all they did was drive me around because only they could open the locks - that wasn't worth the 3% commission they get (even worse was when I used Foxton's to buy where the Foxtons realtor was absolutely fantastic and the seller's did nothing, Foxton's only got 1% and the seller got 5%). On the other hand I've also had realtors who were able to tell what we did and didn't like about a house and were able to guide us into a more appropriate purchase - without regard to the size of their commission. Because they went out of their way with the customer service they deserve their commission. It's the entitled attitude of some people that breeds contempt and the associated lack of service when they don't get what they think they deserve. As I mentioned this isn't directed towards you directly, just towards the out of context statement that probably doesn't represent what you really mean.

I agree with you about realtors. I have a real estate license although I dont sell any more I am more of an investor I still have my license. I am not trying to defend realtors but when I did sell real estate I drove a lot of people around using expensive gasoline and putting miles on my car. I would show them houses see what they were interested in, spend hours on research and show them more houses. After a week or two of showing houses something new would come on the market and I would call them up to tell them about it. The client would inform me that they had been driving around town and saw this house that they just loved. They called the realtor whose sign was posted and when that realtor showed them the house the bought it. One of the first things all realtors in this area do is inform their clients that any house that has a realtors sign on it can be shown by any realtor. If they see anything they like just call us and we can show it to you. What if the medical profession was run that way. Doctors not getting paid until they cure the disease not while they are treating you. How would they feel if they had been treating a patient for two weeks and the patient called and said I ran across an ad in sundays paper by doctor new idea and I called him and he cured me so I am paying him and all the time and money you spent treating me I am not paying you for. That sounds ridiculous but that is exactly what happens to realtors all the time.

One of the reason that only realtors can open locks is that gives some acountability to who goes in the house. Most realtor lock boxes record who opens them. If something gets damaged or stolen it points out who had been in the house.


I am not knocking the medical field and actually in my opinion for the most part their customer service is vey good. Yes you have to wait in the waiting room but it is not a job where a doctor can say I am only going to give this patient 13 minutes then leave whether I know what is wrong with them or not. Doctors provide a lot of services. Are they expensive absolutely but they have a lot of time, and money invested in getting where they are at. They should be paid accordingly. The more you invest the higher your overall rewards are.

 

[gemini5362]

I'm not sure what to say that I haven't already said, but yes, in the interest of public health...in other words, in the interest of the fewest people being harmed, I think it is best that many medicines, most importantly antibiotics, remain prescription only.

And you yourself use the words 'certain drugs'. If you think it would be a better world if people could get medicine without a visit to a doctor then why not ALL medicine? Narcotics, antipsychotics, chemo, anti-arhythmics, stimulants, anti-coagulants. Do those sound to scary? Why? So if even you think only certain drugs should be prescription then who decides which ones? You? Me?

And your continued reference to antibiotics is pretty clear evidence to me that antibiotics in particular need to remain prescription only. You clearly don't understand, or don't want to understand the implications of inappropriate use of antibiotics for yourself or the population at large. There hasn't been a significant develop in anti-bacterial therapy in years and strains of bacteria like MRSA are getting harder and harder to treat. Inappropriate use of antibiotics is the cause. The level of inappropriate use would skyrocket if antibiotics could be obtained by people, like yourself (and most everyone else) who have no clue what they are doing.

In addition to that, how would the average citizen know that 10% of people who have anaphylaxis with penicillin could also have anaphylaxis with cefdinir? How many people would have to die making that mistake before some genius decided maybe everyone shouldn't have access to antibiotics? Would you recognize the symptoms of Stephens-Johnson syndrome, or erythema nodosum resulting from certain classes of antibiotics? Would you know which flouroquinalones would interfere with your Coumadin levels or shorten your Q-T interval in combination with other medications?

All of that is not to sound smart, its all common stuff to physicians, but it isn't common stuff, or even manageable to non-medical personnel, its to point out that a cough or a sore throat does not equal an antibiotic and that there is a big difference between an antibiotic and a Hall's mentholyptus.

In short, yes.

You are entitled to your opinion and while I agree with you that the average person would not know the examples you give. How often do doctors not get a good background from the patient and make just such a mistake. Or how often does a patient see multiple doctors. Right now I have three doctors I see on a regular basis a general practioner, a pulmonologist, and a cardiologist. What if one of them prescribes a medication. I start taking the new medication and a short time after I start taking it I get pneumonia I go to see my doctor and am feeling so bad I forget to tell me doctor about the new medications I am taking so my doctor prescribes something that fatally interreacts with it. I personally trust my pharmacist to watch out for drug inter reactions. I shop at the same pharmacy and my pharmacist knows exactly what medications I am taking.

I hate to let the cat out of the bad but there are a lot of people that are buying medications that are not doctor prescribed. You can go to mexico and buy them. A lot of people that live on the border do that. There are a lot of people who dont have insurance that goes to the local feed store and buy animal antibiotics when they think they need medication. Some people just go to the pet store and buy antibiotics for pets. There are people getting anti biotics without doctors prescription now. I would just like to see it be available in an american pharmacy.


I am just using antibiotics as one example. Personally the only drugs I would like to see require a doctors prescription are drugs that are addictive. I dont think anyone should be able to just go to the pharmacy and get valium for instance.

 

[gemini5362]

Just to have an on topic post I made a purchase today at an ATWOODS. I am not sure how big a chain they are and who knows what that store is. To me they are like a discount TSC store. I bought a new tiller today. When I paid for it they issued a pickup slip. A clerk took it back to the repair section of the store where they put oil in it and gas and made sure it was operational before they loaded it for me. That did not take very long but Iwill make sure that I recommend them for others buying gas powered products.

 

[N80]

You are entitled to your opinion and while I agree with you that the average person would not know the examples you give. How often do doctors not get a good background from the patient and make just such a mistake.

This does not argue in your favor. If the professionals who do this can screw it up, then non-professionals will screw it up even worse. The fact that we doctors make mistakes just shows how complex this is and is not some sort of 'excuse' to let people with less medical experience do the same job.

Or how often does a patient see multiple doctors. Right now I have three doctors I see on a regular basis a general practioner, a pulmonologist, and a cardiologist. What if one of them prescribes a medication. I start taking the new medication and a short time after I start taking it I get pneumonia I go to see my doctor and am feeling so bad I forget to tell me doctor about the new medications I am taking so my doctor prescribes something that fatally interreacts with it.

Well, I'm sure you will agree that that is a two party screw up. It IS a patient's responsibility to give their doctors pertinent information. It IS a doctors responsibility to solicite that information.

I personally trust my pharmacist to watch out for drug inter reactions. I shop at the same pharmacy and my pharmacist knows exactly what medications I am taking.

And that's great. But many, if not most, patients get their meds from multiple pharmacies, often through the mail, the VA, etc etc. So while that might be fine for you, it isn't the norm. So that does nothing for your argument either.

I hate to let the cat out of the bad but there are a lot of people that are buying medications that are not doctor prescribed. You can go to mexico and buy them. A lot of people that live on the border do that. There are a lot of people who dont have insurance that goes to the local feed store and buy animal antibiotics when they think they need medication.

A lot of people huff paint and freebase cocaine. People drive without seatbelts. A lot of diabetics drink 2 liter regular soft drinks daily and a lot of people with heart disease eat at McDonalds. A lot of people experiment with their friend's medicines. So don't worry, people doing stupid things is a cat that's been out of the bag for a long time. And I'm not even going to get into the stupidity of buying important medications from across the border in Mexico! But make no mistake about it, its that kind of behavior that keeps me a busy man.

Some people just go to the pet store and buy antibiotics for pets. There are people getting anti biotics without doctors prescription now. I would just like to see it be available in an american pharmacy.

Again, my job is not to be a 'stupid police'. You can't legislate, or even enforce common sense. Ignorance is the most dangerous disease in this country.

am just using antibiotics as one example. Personally the only drugs I would like to see require a doctors prescription are drugs that are addictive. I dont think anyone should be able to just go to the pharmacy and get valium for instance.

You're just exposing your lack of understanding here. Valium is harmless compared to antibiotics and the other medications I listed above. Makes you about as sleepy as a benadryl and about as drunk as a beer. This is another perfect example of why people like you (the general population) should not have access to prescribed medications without a prescription. You simply do not understand. And I don't think I can help.

But remember. It isn't up to me. My opinion is no more important than yours. This is a government issue. If you think it needs to be changed, contact your elected officials.

 

[gemini5362]

It's not quite that simple. First of all, if you can't afford medical care you should look into Medicaid and/or free clinics. Second, the cost of the doctor's visit will likely pay for itself in the number of people who buy the wrong medication - just because the symptoms are the same doesn't mean the disease is the same. Finally, the lives saved passively by allowing doctors to monitor the community for drug resistant varieties is priceless. It's a tradeoff, you're increasing the cost of health care a little but you're increasing overall health quality by a lot.

Actually medicaid is rather hard to get. If you have a job it is next to impossible. I have a son making 8.00 per hour he would not qualify for medicaid but try living on those wages sometime.

Free clinics are often hard to get into also. I think in the city I live in there is one free clinic for all the people that have jobs but dont have health benfits. I have not been there so I dont know how long the waiting list is to see a doctor but i would imagine that it is fairly long.


The overall problem that I seem to be concerned about is highlighted by your statement that " your're increasing the cost of health care a little but you're increasing overall health quality by a lot." Assuming that statement is correct. The bare plain facts are that in the United States a lot of people do not have health insurance and cannot afford health care. They have no one monitoring them for drug resistant varieties. Giving the general public a chance to get drugs by walking into a pharmacy is one way of lowering the cost for health care. You and george can say what you want but it is done in other countries. I have lived in other countries where that is done and the cost of health care is lower. If George is correct that it will increase his buisness then good for him he will be able to recoup the investment that his education cost him that much more quickly.

 

[gemini5362]

This does not argue in your favor. If the professionals who do this can screw it up, then non-professionals will screw it up even worse. The fact that we doctors make mistakes just shows how complex this is and is not some sort of 'excuse' to let people with less medical experience do the same job.



Well, I'm sure you will agree that that is a two party screw up. It IS a patient's responsibility to give their doctors pertinent information. It IS a doctors responsibility to solicite that information.



And that's great. But many, if not most, patients get their meds from multiple pharmacies, often through the mail, the VA, etc etc. So while that might be fine for you, it isn't the norm. So that does nothing for your argument either.



A lot of people huff paint and freebase cocaine. People drive without seatbelts. A lot of diabetics drink 2 liter regular soft drinks daily and a lot of people with heart disease eat at McDonalds. A lot of people experiment with their friend's medicines. So don't worry, people doing stupid things is a cat that's been out of the bag for a long time. And I'm not even going to get into the stupidity of buying important medications from across the border in Mexico! But make no mistake about it, its that kind of behavior that keeps me a busy man.



Again, my job is not to be a 'stupid police'. You can't legislate, or even enforce common sense. Ignorance is the most dangerous disease in this country.



You're just exposing your lack of understanding here. Valium is harmless compared to antibiotics and the other medications I listed above. Makes you about as sleepy as a benadryl and about as drunk as a beer. This is another perfect example of why people like you (the general population) should not have access to prescribed medications without a prescription. You simply do not understand. And I don't think I can help.

But remember. It isn't up to me. My opinion is no more important than yours. This is a government issue. If you think it needs to be changed, contact your elected officials.

I am going to try and keep this short.

1. If professionals screw it up it must be too complex for non professionals to handle. Good arguement basically people without medical degrees are too stupid to read about drugs and make intelligent decisions.

2. Most people get their medications from multiple pharmacies, the va, online etc. Last time I looked the VA kept records of what they give you. I would imagine online pharacies do also but I dont know that for a fact. I think a lot of people have a pharmacy they use for whatever reason ( usually customer service comes into play here) I do not know many people that just walk into the first pharmacy they see and say fill my prescription. Most people I know use one pharacy and stay without until they have a reason to change

3. I am ignorant of various drugs other than the ones I have been prescribed which I try to find out as much as I can about. So if all valium does is make you sleepy then all heroin does is make you feel better so why should either one of those not be available at walmart available without a prescription. I believe I was trying to point out that we might want to limit addictive drugs to having a doctor prescribe them. When I lived in the middle east where I could get antibiotics and similar items without a prescription it seemed like drugs with addictive properties were still controlled through a doctor. Interesting enough my asthma medicine at the time METROTERENOL (sp) was one of the controlled drugs. I am sure that is because of its chemical makeup.


The bottom line is that you would rather see the hundreds of thousands of people in the United States that have very limited health care suffer than to have them able to get medications without prescriptions. Other countries allow people to get certain drugs without prescriptions and the news has not reported the huge epidemics of drug resistant diseases that are running rampage in these countries.


I am curious about one thing. If you have a patient that has been to you with a disease and you have prescribed antibiotics. Two weeks later this patient comes back uncured and with symptoms of the same disease but the patients symptoms of the disease are of less intensity. If you prescribe another round of the same antibiotics do you charge them for this second office call ?