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U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

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Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#281

Post by adrr »

conanbatt wrote: post #235
u801e wrote: post #177

Earlier quoted context omitted.

Is it even possible to set up an individual practice these days? Most individual practices were established decades ago. Most new physicians will work with an established group practice on contract.

Its not because billing is so complicated that it takes up to 50% of the doctors tie to manage his own practice. Big companies have more people doing billing alone than doctors themselves. Pretty clear cut case that regulation is the enemy of efficient markets.

Wouldn't this be a perfect opportunity for a startup to handle billing for small doctor's offices?

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#282

Post by tptacek »

gaius wrote: post #251
tptacek wrote: post #206

Earlier quoted context omitted.

Every visit thereafter.

Not sure how your anecdata is any more or less valid than mine...

I never said it was! My point was just that a pharmacist probably couldn't replicate the routine experience that the large health provider chain my doctor works in provides for patients.

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#283

Post by BurningFrog »

Engineering-MD wrote: post #136
Lanthanide wrote: post #111

I live in a country where this scheme is already the norm (Saudi Arabia) and I can say that while it's not necessarily ideal, I much prefer it to the alternative. It plugs some seriously annoying holes in the healthcare experience and frees up doctors' time for more patients. As it is, the only medications that require a prescription to buy in Saudi are psychotropic ones, narcotics, and most recently, antibiotics. Th…

I’m not I agree. The first reason is that many medications carry significant risks. For instance you mention insulin. For someone already prescribed insulin, yes it should be easy to access in case they should be able to get more (and that is the purpose of a repeat prescription). However, to provide insulin over the counter to someone never previously prescribed it could be incredibly dangerous, and indeed fatal. Th…

This is an entirely theoretical argument.

As OP says, this system exists in the real world and how it actually works can be studied.

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#284

Post by 394549 »

toast0 wrote: post #135
394549 wrote: post #107

Earlier quoted context omitted.

> One can represent themselves. It might be dumb, but people should have the right to be dumb when they're the only ones getting hurt... The difference is there isn't a massive industry that will try to persuade consumers to do something as dumb as choosing to represent themselves pro se. There's no way for others to profit off that kind of stupidity. On the other hand, the drug industry already advertises to consume…

> The difference is there isn't a massive industry that will try to persuade consumers to do something as dumb as choosing to represent themselves pro se. There's no way for others to profit off that kind of stupidity. Wouldn't you like to attend my seminar on the importance of representing yourself? Also, check out my book. And follow me on Twitter.

> Wouldn't you like to attend my seminar on the importance of representing yourself? Also, check out my book. And follow me on Twitter.

That doesn't happen, or at least it doesn't happen at anything close to the scale of prescription drug advertising.

Also, representing yourself pro se is a daunting, complicated endeavor. Buying a pill is not if you have the money, as you can clearly see with the supplement industry.

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#285

Post by LinuxBender »

walshemj wrote: post #125
LinuxBender wrote: post #82

Earlier quoted context omitted.

I agree with this. Many of the supplements I get online are just as risky as anything a doctor can prescribe to me. I already know more about these chemicals and drugs than any doctor I have met. What's more, I have yet to meet a doctor that even cares about the supplements I take.

Yes well I am sure that's what the guy next to me when I was in hospital last year thought until he took supplements plus his prescribed meds and had 100% kidney failure.

What were the results of the autopsy?

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#286

Post by wu-ikkyu »

cimmanom wrote: post #264
wu-ikkyu wrote: post #183

Earlier quoted context omitted.

Could be as simple as having the user input any other drugs, foods, substances, etc. they are currently consuming and then checking for interactions on the back end. There are already many sites that do this.

"The little blue ones and the big yellow ones."

"Results not found. Please read label and try again."

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#287

Post by conanbatt »

adrr wrote: post #281
conanbatt wrote: post #235

Earlier quoted context omitted.

Its not because billing is so complicated that it takes up to 50% of the doctors tie to manage his own practice. Big companies have more people doing billing alone than doctors themselves. Pretty clear cut case that regulation is the enemy of efficient markets.

Wouldn't this be a perfect opportunity for a startup to handle billing for small doctor's offices?

There are several but its not as easy as it sounds. Its a very labor-intensive task. Its kind of like saying that a startup should be going to peoples homes and cook for them according to their liking.

The issue is that doctors work for insurance companies and that means you need to do things a certain way they like while matching the way they practice and document their medical decisions.

I could explain more since I am part of one of these startups :)

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#288

Post by bargl »

RichEO wrote: post #121
bargl wrote: post #43

Earlier quoted context omitted.

100% agree. I'd love to see this in the US. most pharmacists have way more knowledge about drugs, their interactions and other issues that can crop up with prescription drugs. Given a diagnosis they are typically better at prescribing the correct medication than a general practitioner. It's also a lot cheaper than a doctors visit for insurance.

You handwave over “given a diagnosis” like it’s an irrelevant detail. You appreciate this is the largest part of the problem, surely?

I don't think it's the place of a pharmacist to diagnose people. But I do have a friend who's a pharmacist and they see doctors consistently poorly picking medicine for things they've diagnosed.

I get that the initial diagnosis is the biggest part. But there is a ton of domain knowledge in drug interactions, expiration, etc that doctors just don't deal with on a daily basis. It makes sense to separate the jobs so each individual can get the best at their role. I don't mean to undermine diagnosis that's a huge deal, but I'd love to see doctors focus on what they do best.

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#289

Post by jlg23 »

Engineering-MD wrote: post #136
Lanthanide wrote: post #111

I live in a country where this scheme is already the norm (Saudi Arabia) and I can say that while it's not necessarily ideal, I much prefer it to the alternative. It plugs some seriously annoying holes in the healthcare experience and frees up doctors' time for more patients. As it is, the only medications that require a prescription to buy in Saudi are psychotropic ones, narcotics, and most recently, antibiotics. Th…

I’m not I agree. The first reason is that many medications carry significant risks. For instance you mention insulin. For someone already prescribed insulin, yes it should be easy to access in case they should be able to get more (and that is the purpose of a repeat prescription). However, to provide insulin over the counter to someone never previously prescribed it could be incredibly dangerous, and indeed fatal. Th…

[on the risks of self-medication]

I currently live in the Maghreb and the situation is here as it was described for Saudi Arabia. An important difference to Western countries is that pharmacists seem to play a much more important role here: I have to justify every purchase (even for very common broad spectrum antibiotics) and locals tell me they regularly seek advice at the local pharmacy first. Think "doctor's appointment pre-screening". And my highly subjective impression is that the quality of this pre-screening surpasses service in western pharmacies by far.

Though, the problems you point out are very real, just mitigated by the different situation.

Another thing that makes the situation incomparable to western countries is the low density of qualified doctors: If you need psychotropics here in my village you would have to move several hours away into the next big city to do a therapy. So it is: diagnosis, prescription and off you go. One can go on with a single prescription for years and I dare to say that the debate on whether this is good or bad here is still open.

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#290

Post by cestith »

walshemj wrote: post #29
cestith wrote: post #12

Earlier quoted context omitted.

I'd actually hope not. Many people have chronic conditions which require periodic visits to a doctor mainly for the same prescription to be renewed. A doctor should absolutely be involved in follow-up management, but don't make patients go every two or three months just to get the same prescription as last time and to get insurance to cover the meds. Once a chronic but potentially well-managed condition is diagnosed,…

As some one who has lived with a serious chronic condition id say the opposite - I don't have anyting against my local pharmacy (and they have been good and even hand delivered meds ) But I suspect that they probably have two at most patients like me as opposed to the nephrology specialists who see dozens of people like me each week.

Are there easy at-home tests that would be useful data for your doctor? Is once a month necessary for this specific condition? Is three months? What about keeping records and sending them to the doctor every couple of weeks so an extra appointment can be scheduled, but only once every four or six months normally?

I have hypertension. I've had it for years. It doesn't just go away, but it doesn't (at least in my history) rapidly get worse. I can take my blood pressure at home and chart it. The same medication I have always taken works and at the same dosage. Yet most doctors want to see me every two months to renew the prescription, prescribing a one-month supply with one refill. The stuff's shelf stable for a few years. Why can't I get a six month prescription?

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