Wednesday, October 8, 2008

Is it right to prescribe generic medications?

When I first meet patients, I normally try to prescribe the best medication for the least cost. This is the practice of good medicine in the 21st century: be sensitive to the cost of medications to the patient. If the medication happens to be generic and sold over the counter, so be it. Many patients are not aware that the optimal use of medications, even over the counter medications, may be strong enough to treat their condition or disease. Countless other times, I have prescribed the best medication, which they have not been prescribed yet, but it is tier 3, or in other words likely to cost from $40 on up to hundreds of dollars. Within one day, my office gets a phone call from an unhappy patient saying that they want whatever is the generic medication on their drug formulary even if they have tried it before or they are informed that in my opinion it is highly unlikely to provide them with relief. For this reason, I encourage patients to always bring their formularies to office visits with me. I try to work with them, which is why 99.9% of the time I sign in the lower right corner of the prescriptions: substitutions permitted, if safe, generic equivalents are available.

This approach recently got me into "trouble." A new patient called the day after her visit and demanded to have her records transferred. Her reason: she was very irate (to my staff) because why should she pay all that money for allergy testing and then be prescribed an over the counter, generic medication to treat her disease? She wanted her doctor to prescribe a good, name-brand medicine. By the way, in our initial meeting, she denied ever using the medication recommended and said nothing about this at the end of the visit when it was explained to her that in her case, considering all of the variables, that the most reasonable, first step, would be to try the generic, over the counter medications first, before moving up to tier 2 & 3, more expensive, name-brand medications. Epilogue: despite explaining our decision making process, she switched practices; I am not going to reduce my sensitivity to the cost of medications for patients by avoiding generics.

What were the lessons to me? 1. The practice of medicine is getting increasingly complex. 2. Be prepared despite your honest, very best efforts, to not please every one. As Roseanna Roseannadanna said,"Well it just goes to show you, it's always something." 3. Keep trying your hardest.

If you have questions about your medications, bring your drug formulary with you to your doctor's visits and then ask your doctor!

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