Why do doctors prescribe ineffective drugs? The attending physician does not write a prescription for subsidized drugs. Why do doctors not prescribe cheap drugs?

Recently, it has become increasingly difficult to trust doctors. Instead of prescribing the most effective treatment, while weighing the patient's capabilities against the cost of the drugs, doctors do not hesitate and prescribe expensive drugs to patients.

I went to the pharmacy, and the pharmacist selected analogues of these medications for me. As a result, I spent only 600 rubles on treatment. There at the pharmacy they told me that many doctors now practice concluding contracts with pharmaceutical representatives, according to which the doctor prescribes exactly the medicine that they supply to pharmacies, and in return receives a percentage of sales. After the course of treatment, when I came to my doctor and said that I was taking exactly what he prescribed, I heard in response: “You see what good drugs I prescribed for you, how quickly you recovered...” says Arutyunova.

Situations like this are not uncommon. It happens that doctors not only prescribe a specific medicine - and it will not necessarily be the most expensive among its analogues - but also send the patient to a specific pharmacy, citing something like “it’s cheaper there” or “quality is guaranteed there.” Some particularly quick doctors try to frighten their patients: if you don’t buy this particular drug in this particular pharmacy, then by the evening you will feel very bad...

Health workers themselves are reluctant to comment on this problem. Only on the basis of anonymity, a psychiatrist at one of the neurosis clinics in St. Petersburg agreed to tell News Agency exactly how doctors turn into sales agents, selling not food or clothes, but our health.

Everything happens very simply. A representative of a pharmaceutical company comes to see a doctor at a city clinic or private clinic. He quickly and beautifully talks about the miraculous properties of a particular drug and suggests that the doctor prescribe it, and for his “work” he can receive either a percentage of sales or a certain fixed amount - both in cash and on a card. At the same time, the offers “you prescribe our drug, and we give you a percentage” most often come from manufacturers of drugs that are inexpensive compared to original drugs and low-quality generics, says the psychiatrist.

According to her, a good doctor will always explain the difference between a brand-name drug that has passed clinical trials and drugs that did not participate in these trials, and then it’s up to the patient to choose. If a doctor manically imposes a specific medicine, it is worth thinking about why he is doing this, whether there is any personal benefit for him.

Intimate talk

It happens that people come to us with such complaints. A teenager and his father come to see a doctor, and it is written on their faces that their income level is not only far from perfect, but even from the average level, but the doctor still prescribes a certain drug and sends the patient to a certain pharmacy, says Galina Kozlovskaya, Chairman of the Consumer Society of St. Petersburg and Leningrad Region.

According to Galina Kozlovskaya, if a similar story happened to you, and the doctor prescribed you an expensive medicine, but did not want to hear about the existence of analogues and about your difficult financial situation, you need to go to the head physician or medical director of this medical institution and demand that the authorities pay attention on the behavior of his subordinate.

In turn, consumer rights lawyer Igor Solomonis notes that the first thing to do in such a situation is to try to have a heart-to-heart talk with the doctor and ask him to prescribe something less expensive.

In our country, it so happens that the high price of a drug is not a guarantee of its effectiveness and quality. I personally have encountered this several times. You go to the doctor, and instead of normal treatment, he offers you to go to a specific pharmacy and buy a specific product, while some even give you their card number. Like, if I give this number, I’ll get a discount,” says Solomonis.

According to lawyers, there is essentially no mechanism to control this problem. A doctor prescribes this or that medicine, as they say, according to his inner conviction. He is sure that this disease is best treated with this drug. Therefore, it is almost impossible to prove the fact of collusion between the doctor and pharmaceutical representatives. Even in the case when a doctor sends a patient to a specific pharmacy, he can say in his defense that he himself personally bought this medicine there, and therefore knows that it is good and cheaper than at the pharmacy on the next street.

As they say in the Office of Roszdravnadzor for St. Petersburg and the Leningrad Region, their department has not received such complaints. People seem to be trying to solve this problem on their own. On the other hand, many simply do not know where to turn in such situations. Any medical institution should have an information stand that indicates the contacts of a higher-level organization. If a medical institution is a city subordinate, then it is managed by the Health Committee, if federal - by Roszdrav. It is to these two departments that you need to write complaints about negligent doctors.

Proving the fact of collusion between a doctor and a distributor is theoretically possible, but very difficult. And taking into account the fact that we do not have such practice, since there were no corresponding complaints, it is difficult to say how this will happen in reality. However, if there are still such complaints, our department will carry out unscheduled inspections, Roszdravnadzor specialists promised.

During a public opinion poll, which involved 1,500 people from 44 regions of the Russian Federation, it turned out that almost a third of respondents believe that doctors, when writing prescriptions, are guided not only by the patient’s condition, but also pursue personal gain. 8% of respondents are confident that they “collaborate with pharmaceutical companies and push their medicines.”

The opinion that doctors focus not only on the patient’s condition is more often shared by people with higher education (45%), residents of Moscow (48%) and megacities (45%). Those who believed that doctors were motivated by reasons other than the health of their patients were asked an open-ended question about what additional considerations influenced their prescribing.

A third of respondents (8% of the sample as a whole) believe that doctors can act as distributors of medicines under an agreement with pharmacies or manufacturing companies: “doctors are assigned to pharmacies and receive interest from prescriptions written”; “a pharmacy enters into an agreement with a doctor, and he recommends those medications that need to be sold to the pharmacy,” “if they cooperate with a certain drug company, then they impose its drugs.”

Another 5% of respondents take an essentially similar position, stating that doctors are driven by considerations of personal gain, profit (“personal benefit from the sale of medicines”; “personal interest of the doctor”; “taking more money from patients”).

The same number believe that doctors are guided by the patient’s financial situation, the availability of this or that medicine (“whether to buy expensive medicines or not”, “the patient’s ability to pay”). Among the reasons for prescribing a medicine, advertising and the promotion of new drugs by doctors are also mentioned (“they advertise what they bring”).

Some respondents are confident that a doctor, when prescribing a medicine, relies on his own experience and professional habits, and this is assessed both positively (“the doctor’s own experience, his level of qualifications”) and negatively (“there are illiterate doctors: in format, what was accepted earlier, then they write it out", "they work according to a template").

Some believe that doctors strive “to buy expensive drugs,” others believe that they, on the contrary, “prescribe the cheapest and most ineffective pills.”

The problem of some doctors being biased by representatives of pharmaceutical companies is not new. Indeed, in recent years of “market relations” a fail-safe scheme has emerged: the patient is given a prescription with an impressive list of drugs. As a result, people often purchase expensive medications that they do not always need.

Every week, representatives of the distribution company visit pharmacies to collect prescriptions with exclusive brand names and codes for further payment of dividends to doctors. The profit is substantial - the fee for the treatment itself plus interest from the sale of medicines.
It is especially beneficial for physicians to promote wealthy patients who do not skimp on their health. Cases have been recorded where large businessmen, after a course of such “treatment,” ended up in intensive care at best, and in the next world at worst.

It is no secret that medicine trading is one of the most profitable types of business in all countries. At the same time, prices for medicines and medical services are constantly rising. Profits from the sale of medicines are deposited in the accounts of representative offices of foreign pharmaceutical companies operating in the country, several domestic drug manufacturers, as well as pharmacies where the products are sold.

At first glance, the doctor is outside the circle of people involved in this business. Financial flows from the sale of pills pass him by, although the doctor himself is an important link in the super-profitable chain: patient - prescription - pharmacy - medicine. However, the assumption that the treating doctor’s pocket is empty is erroneous.

In fact, almost all specialized doctors in clinics and hospitals willingly make deals with representatives of pharmaceutical companies, receiving a reward for prescribing a set of medications to gullible patients. In this case, the scientific degree of the specialist plays a role - the higher the rank, the more significant his “bonus”.

It is important to pay attention to this detail - such a conspiracy cannot be called criminal. It is difficult to prove that the doctor is unscrupulous in this matter. Representatives of pharmaceutical companies, as a rule, set up an entire network to attract doctors to sell their drugs. They often hand out ready-made prescription forms with a tear-off coupon or specific signs. All the doctor has to do is enter the names of the medications and the patient’s name into the prescription and send it to the pharmacy.

Such prescriptions allow distributors to control exactly how much of their medicine a doctor prescribes, whose diligence is well rewarded. Most often this is cash, but there are also expensive gifts or paid trips to so-called seminars organized in warm countries, where businessmen, but not ordinary therapists, usually spend their holidays.

Subsequently, having gained a taste for it, doctors began to cooperate with several companies at once. Moreover, since the difference in price for similar medications from different manufacturers can be up to 20%, doctors were advised to prescribe more expensive medications.

Good afternoon.

1. To receive discounted medications at a pharmacy, you must write out a prescription for them from your local doctor. The basis for issuing a prescription is a written recommendation (extract) received from a specialized medical institution where the patient is observed for his underlying disease.
2. The local doctor may refuse to issue a prescription due to the lack of this drug in the pharmacy. This refusal is illegal, because even if the drug is not currently in the pharmacy, upon receipt of the prescription, the pharmacy is obliged to purchase the drug specified in the prescription within ten days. If there is no prescription, then the pharmacy is not obliged to do ANYTHING, and you will never see the medicine. Therefore, you need to “remind” your local doctor about this and continue to insist on writing out a prescription. 3. If the doctor continues to refuse to issue a prescription, demand it and write it down on the card: “the prescription was not issued due to the lack of medicine in the pharmacy.” He cannot write something like that, so he will either write out a prescription or refuse to write down on the card that he did not write it out. In this case, it is necessary that the doctor MUST make an entry in the card stating that the patient on such and such a date was at an appointment and was examined by a doctor on such and such (he will not be able to refuse this).
4. Immediately after leaving the doctor’s office, write a complaint in 2 copies addressed to the head doctor of the clinic with approximately the following content: “To the head doctor so-and-so from so-and-so... Please explain on what basis the therapist so-and-so refused to write me a prescription for medicine (name) , necessary for my life's indications. I consider this refusal illegal on the basis of Order of the Ministry of Health and Social Development of the Russian Federation dated February 12, 2007 N 110, Decree of the Government of the Russian Federation dated July 30, 1994 No. 890...
5. Give one copy of the letter to the secretary of the head physician, ask the secretary to put a stamp on the second copy.
6. If the secretary refuses to accept the complaint, you must send it by mail - registered mail with a list of attachments and acknowledgment of delivery. The inventory will be given in two copies, one to be placed in the letter, the second to be attached to a copy of the complaint stored in your home. Attach there a receipt for payment for a registered letter and a notice of receipt of the complaint signed by the secretary of the head physician. 7. In the future, act depending on the reaction of the head physician. He may offer to agree verbally, but it is necessary to insist on a written response. After this, a prescription for the medicine is usually given.
8. If unsubscriptions begin (the Department of Health prohibits prescribing this medicine, there is no money in the budget, etc.), then you need to contact the prosecutor’s office, the regional Ministry of Health, Roszdravnadzor (you can go to 3 of these places at once). Send there COPIES (not originals) of all documents (your complaint, postal documents - list of attachments, receipt, delivery of notification; responses from the head physician). If there was no response from the head physician, you can safely complain to the prosecutor’s office. Usually, after a complaint to the prosecutor's office, doctors themselves call home and ask when it is convenient for you to come for a prescription.

How does a doctor think when he prescribes a drug?
How does a doctor prescribe medications psychologically?
Medical psychology of drug prescription.

Let's take a simple logical route - from the opposite.
(here is a funny video clip))) for this phrase)

Regular, maximally repeated, repeated, constant purchase of a drug at a pharmacy is the end result that the pharmaceutical company wants from each target patient.

This action is preceded by the formation of a habit in the patient - to buy this particular drug.

The habit is formed by periodic purchases, which are made either by the patient himself, after having once prescribed a drug by a doctor, seeing the result of its use, or by a doctor’s prescription, which force the patient to buy the drug, thus accustoming him to constant purchases.

And we will look at the operating system in detail to understand what links are included in it and try to understand how they can be influenced when persuading a doctor to prescribe drugs.

The operating system is represented by the following links:

1. image/picture/representation
2. meaning for the doctor/basic need/personal meaning
3. action plan
4. the process of performing the action/the actual process of prescribing the drug/explaining to the patient and issuing a prescription

How it works for any person (psychology).
1. A person thinks - an image appears. The image is built on the basis of experience and is completed as a specific situation arises, adjusting to the circumstances.
2. During correction and analysis, the most and least important aspects of the situation are automatically determined, based on the existing/exciting/significant needs right now in a particular situation.
3. A decision is made and a virtual action plan is built. Sometimes it is habitual, stereotypical, if the situation is standard; if not, analysis and correction occurs.
4. A specific action is performed, which is monitored during its implementation and corrected if it deviates from the planned plan.

Now let’s look in detail at each link of the doctor’s indicative reaction at the appointment, which precedes and controls the action. And then we’ll think about how the medical representative can influence each link for the “correct” discharge.

An image is an element of the human psyche, a doctor. Roughly speaking, the doctor thinks in images. The image of a doctor in our context is the situation in which the doctor and the patient find themselves.

The doctor receives the patient, interviews, examines, examines, makes a diagnosis, prescribes additional examination methods, prescribes treatment, writes a treatment regimen/prescription.

The doctor somehow imagines this. The doctor imagines this in the form of an image. And when he finds himself in a situation, he works with this image and builds an action plan according to the image he represents and compares it with the real situation.

In other words, we can say that the doctor always foresees/knows/calculates various options for the development of events during an appointment and almost always has a stereotypical approach, stereotypical patterns of behavior into which the patient’s portrait (symptom complex) fits, corresponding to a specific diagnosis and a specific treatment regimen with specific drugs.

Do you recognize points of influence for persuading a doctor to prescribe your drug?

Obviously, a medical representative’s excellent tool for convincing a doctor is discussing a detailed portrait of the patient and drawing an image of possible situations that may arise at the appointment. And then connecting this image with the updated indications of a specific form of release of the drug, suitable for the treatment of a specific pathology in an absolutely specific patient.

For example, if a medical representative sets a goal to replace a competitor’s drug with his own drug, sometimes it is enough for him to draw a portrait of the patient that does not fit with the indications/available doses/formulations of the competitor, and the competitor will fall off by itself... Do you understand? That is, you don’t even need to talk about the advantages of your drug and update the disadvantages of your competitor. The doctor himself realizes everything, based only on a comparison of indications/doses/forms of release with the image of the situation/portrait of the patient...

2. Implications for the doctor.

This is the dominant need/significance/meaning that is important, which prevails in the specific reception situation. As you understand, significance can have different points of application. vast, but here and now one thing prevails.

Do you catch the red button to influence the doctor?

In essence, these are the benefits of the drug that are spoken out and updated by the medical representative upon convincing the doctor. But here it is important for the medical representative not just to parrot out some possible advantages and benefits that “will fly into one ear and fly out of the other,” but to try to link/parallel them with the previous stage - image, experience, clinical situation, specific a problem that will concern/excite the doctor and, at the same time, solve the problem.

3. Action plan.

Doctors work very quickly and think when prescribing treatment regimens. If the medical representative’s drug is in the regimen, great. If not, you need to insert it there. How?

This is the third step. After the image and the important meaning, you need a plan of action. An action plan is a treatment plan.

The task for the medical representative is to agree that his drug will be included in this scheme. But this scheme must be glued to the image and have meaning for the doctor. Therefore, the agreement between the medical representative and the doctor to include the drug in the regimen is not a separate task, but the next task/activity of the medical representative that logically follows from the previous two stages.

4. Discharge process.

Also, an incredibly important next logical step.

It is important to prescribe correctly and, at the same time, convince the patient to buy the drug. Convince you to buy this particular drug, which is prescribed and prescribed by the doctor here and now.

Many medical representatives miss this stage and then complain that the doctor prescribes it, but the patient does not buy it, or the drug is replaced at the pharmacy. The medical representative is to blame, no matter what anyone says.

If the doctor:
- formally writes out,
- waves a stack of prescriptions with the prescribed drug in front of the medical representative’s nose,
- demands “thank you”, gets offended,
- at the same time loudly declares that his case should be discharged,
- whether the patient buys or not is not his concern,
- in the pharmacy the drugmaker easily changes the drug and the patient does not mind,

All these are markers of the medical representative’s shortcomings, no matter how unpleasant it may be for the medical representative to realize this. The reason is a flaw in the fourth stage. You can read about doctor deception here: .

The doctor must have a scheme in his head, doses, release forms, options for combining drugs - and this is the job of the medical representative. Printed materials, cheat sheets, reminders and just constant repetition will help here. Repetition is the mother of learning. The medical representative must always remember this and not get tired of repeating the same thing over and over again.

In fact, the doctor must have phrases, words, examples, arguments that will convince the patient to buy the prescribed drug and prevent attempts at substitution at the pharmacy. The doctor himself will find arguments if the medical representative performed all three previous stages efficiently. But often the medical representative must help the doctor find words, jointly develop speech modules, speak, identify phrases, examples and arguments that will help the doctor in convincing the patient.

So, a resume for a medical representative:

1. Working with a portrait of a patient during a doctor’s visit
2. Compare the portrait with the release form and what is significant for the doctor
3. Develop a treatment plan/scheme with specific formulas
4. Agree on specific actions when prescribing the drug

If you have any questions, knock on Skype: primusinterpares2013
Call: +79096370055

Good luck and enjoy your work!
Especially its fruits!

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