Last week I had an appointment with one of my well-controlled diabetics. She has been in my care for the last six years. Our usual cheery interaction turned sour when she stated in an accusing tone, “My husband is diabetic, and I talked to his doctor about the medication you have me on. He says it is junk, and he only writes it for poor people, and he doesn’t understand why you have me on this drug when I could be on something better.”
After this rather shocking speech, she sat back with a smug “gotcha” look. After secretly wanting to punch her husband’s doctor in the face, I sat back and sighed, explaining my reasoning for having her on this medication that is only for poor people.
First, we went over her hemoglobin A1C. This test allows me to tell what her average sugar has been for the last three months. This number should be less than seven in young diabetics. My patient was at six. So, first of all, the “poor people” medication is effective.
Secondly, we went over the guidelines and how the American Diabetes Association (ADA) encourages the consideration of both effectiveness and cost of medicines. The medication for “poor people” has an average cost of about fourteen dollars per month.
Thirdly, the ADA also recommends considering side effects, and because this “poor people” medication has been around for many years, we are well apprised as to the possible consequences of being on this medication long term.
Finally, the average cost of the medication her husband’s doctor was suggesting was around three hundred and eighty dollars. Granted, she could get a really good coupon for this medication, but even “rich people” would probably feel swindled by this price when there is an effective, cheaper option.
After this rather lengthy discussion, the patient’s “gotcha” look faded to a confused, ashamed nod of agreement. She sheepishly asked me, “So why do you think my husband’s doctor would recommend me taking this medication?”
I kind of shrugged and let it go, but find myself asking that question now too. Why indeed would her husband’s doctor feel the need to use a three hundred and eighty dollar medication as first-line therapy when a fourteen dollar medication would do the trick? Why would he feel so strongly about this as to impugn a fellow physician?
I don’t know the answers to these questions, but unless doctors become more involved in making good decisions that provide patients with low-cost, effective alternatives for care, then the rising cost of medicine will never be reigned in.
Kellie Wilding is a family physician.
Image credit: Shutterstock.com
