The Essay:
I hardly noticed the small, purple nametag and I honestly can't remember where or when I got it. Perhaps I found it lying around an ER when I worked on an ambulance in college. It dangled from my stethoscope at the bifurcation and it served an important function: identifying the black, Littmann, doctor's tool as mine. The tag also served an additional function, which didn't seem to bother me when I first started carrying the stethoscope to physical diagnosis class as a first year medical student. The tag read "Zithromax (Azithromycin)" more clearly than the faded ink of my handwritten name.
How did my classmates perceive this nametag? Perhaps it appeared as standard-issue physician apparel, something my classmates could also expect to receive someday. It was a year later when I finally tore that tag from my stethoscope because a friend noticed it and was dismayed that I was willingly advertising for Pfizer as a medical student. I hadn't given it much thought previously, but I agree with her wholeheartedly; it is irresponsible for health professionals to sit back and let the pharmaceutical industry compromise our integrity with free pens and free lunches—the buck stops here. It is now the imperative of medical students to take a stand against drug companies' unethical influence on physical prescribing practices. Widespread approval (or acquiescence) on behalf of medical institutions, doctors, and society at large places the burden on the medical student to decide that private industry's involvement in healthcare and medicine is coercive.
Coercion requires a vulnerable party. Why are doctors, doctor's lunch time, and doctor's free time so easily bought? The medical school bookstore sells un-branded stethoscope nametags for $3.99, why would I cherish having one for free? There is an insidious culture of entitlement going around in medical school these days and it's based in three statements medical students tell themselves: one is true, one is fiction, and one is completely irrelevant. Respectively, "medical school incurs tremendous debt"; "medicine doesn't pay what it used to"; "I could have been an investment banker". Plus we've all worked really hard to get into medical school. It's natural to feel entitled to something, but the answer is clear: we are entitled to a career of tremendously rewarding work, we are entitled to earn in the highest tax bracket someday, but we are not entitled to let commercialization and capitalism affect patient care. And we are certainly not obliged to do drug companies' advertising for them.
So why have generation Y's soon to be physicians been slow on the uptake (or downtake)? Because we stayed at home with babysitters when our physician parents went out to drug company-sponsored CME events and because we came of age during the era of direct-to-consumer drug advertising; we expect handouts because they are all around us. Medicine is a hierarchy, with many assumptions posited by forefathers. Challenging these assumptions doesn't come naturally or easily, even when the popular press has begun to scrutinize big pharma's interaction with the medical profession. How many third year students could look an attending in the eye and decline an invitation to attend grand rounds (and a free sandwich) sponsored by a drug company? As medical students we seek to be accepted into the club, often without being equipped to critique the club's policies.
It is much easier to change people's expectations than to deprive them of things they expect. All we have to do is remove the expectation of perquisites from one generation of physicians and the next crop won't feel entitled to handouts and free lunches. Fortunately for future generations, change is already in the works. Several US medical schools have already instituted policies on keeping drug reps out of teaching hospitals and Community Catalyst's Prescription Project is advocating for change in this area.
I was standing in our student affairs office after an exam my second year and staring up at me from the table where syllabi are distributed was a gorgeous reflex hammer made by a drug company. This unit even had extensions to test for pain and light touch sensation. It was there for the taking. I picked it up, looked around, and thought about slipping it in my pocket to use on rotations. It was fancier than the classic one I already had with its rubber head and silver handle. Plus, this drug company handout was in my office of student affairs, the administration of my school clearly wanted me to have it. Nevertheless, I put the reflex hammer back down on the table and walked away. With continued effort and heightened awareness, refusing drug company handouts will someday be a reflex that I won't need to test.
No comments:
Post a Comment