Are You a Pill-Pusher?

Most doctors would take offense at being called a pill-pusher. However, the everyday work of a physician is filled with opportunities to make compromised prescribing decisions.

Accuse any doctor of being a "pill pusher" and they will most likely take offense. In most instances, it connotes an unethical or unprofessional practice. Worst case, it is fraud.

Yet, let me invite you to a day in the life:

1. A patient with a sore throat is being seen via a telemedicine consultation. The doctors recommends antibiotics for what is most likely a viral URI. Pill pushing?

2. A psychiatrist is a member of a pharma speakers bureau. After signing up there has been a noticeable change in her prescribing habits to a drug that the sponsor makes. Pill pushing?

3. A patient presents with vague complaints and the doctor is not sure what's wrong. He recommends to the patient that she do nothing with the expectation that things will get better on their own or the patient has a disease for which there is no prescribed drug treatment. The patient says, "You mean I paid for parking and a $35 copay and you're not going to prescribe anything?" The doc is 30 minutes behind schedule and writes a prescription. Pill pushing?

4. A patient presents with a problem list as long as your arm. By the time the doctor has entered the information into the computer, a significant amount of the 12-15 minute visit has passed. She writes prescriptions. Pill pushing?

5. A doctor with a significant position in drug company stocks routinely writes prescriptions for drugs made by companies in his portfolio. Pill pushing?

I was banned from being on a pharma speakers bureaus and so were my other medical school colleagues after an edict came down from the Dean. I have prescribed drugs with marginal effectiveness because I was pressured to do so by a patient. I invest in mutual funds that have pharma companies in the portfolio.

I don't consider myself a drug pusher. I think I'm just an ordinary doc like everyone else having to deal with the realities of delivering sick care.