Relationships

Mr. K came to be the other day as a new consultation for his diabetes. I was somewhat surprised, as he had uncomplicated, relatively well-controlled diabetes as reflected by his good hemoglobin A1c. Not the kind of consult I usually see as an endocrinologist. And so I asked him why he was wanting a specialist to treat him and not his GP anymore.
And I was not expecting his answer.

"Because I read in the papers that my doctor was paid $50,000 by the drug companies last year."

There was a recent report in the papers about doctors being paid consultants for pharmaceutical companies. Either being a spokesperson, or giving lectures on certain drugs to other physicians. That report listed the 20-highest paid doctors in the state. And Mr. K's physician was on that list. And the amazing thing was, according to that report some doctors were paid up to $2 million (remember, this is in addition to the doctors' salaries) (that sum was an outlier- for some patents he owned). Many others were being paid well over tens of thousands of dollars a year, presumably for giving talks.

It's a controversial subject, but perfectly legal.The relationship between doctors and industry. Some being for, while many being against. Some clinics have allow visits by drug reps; some strictly do not. In fact I think even more lenient in Asia where drug companies can pay for your overseas trip to a conference.

The obvious benefits of the relationship are, doctors are able to learn about newer medications. The ability to get free samples and discount coupons to be given to patients in the practice.

Downsides, the concern that this may bias the doctors towards more expensive medications. Conflict of interest. And my personal issue (yes, you can tell which position I take): even if it's just a drug lunch or a cup of coffee, ultimately you know this is coming out from the patient's pocket.

And so, I feel a certain amount of guilt knowing that, really, my patients are paying for the meal the drug rep brought to our office. As such, I avoid these as much as I can (admittedly when I was a resident I had less qualms). And the reps know it too- I'm never very chatty or warm with them- and they try to avoid me too unless they need my signature to leave samples for our clinic.

It's a personal, and yet professional choice. And I no longer give talks that are sponsored by a drug company: I did this just once before 3 years ago not knowing they'd pay me to talk about something I was passionate about- only after I got the cheque did I shamefully realize how things work. And so, while $1000 to give a 1-hour talk about thyroid issues is a nice sum, it's something I'd prefer to do without. And I think it helps me sleep better at night.

For apparently, patients like Mr. K agree with me.