Now that drug companies are marketing directly to consumers, we doctors have begun to experience prescribing pressure from an unfamiliar quarter: our own patients. We'll have to learn a whole new way of thinking about doctoring, which is why I spent the day recently following around a makeover artist at the cosmetics counter in one of the area's department stores.
Why do my patients these days sound like they're shopping on the Champs-Elysees? We now need to become conversant with exotic new names for pharmaceuticals that in the past were reserved for hair sprays or Caribbean islands. Allegra better describes a sexy perfume than a widely used hay fever medication. Evista, for hormone replacement, sounds like a line of naughty Argentinian underwear; and as for Celebra, well, the name makes you feel like you could drive off in it and never remember to come to work again, but actually it was the original name for a pill for arthritis. Now it's called Celebrex.
Why do all these drugs, like Splenda, a diabetes pill, end in the letter "a"? The only reason I can think of is to help patients imagine they're touring medieval Italian villages instead of doing something as lackluster as visiting the doctor's office.
Now compare these with the actual trade names of medications that we doctors have to memorize. Raloxifene (for osteopororis) sounds like one of Wotan's mortal enemies, but that's not all; there's a whole army of unpronounceables (these are all real): clopidogrel (for stroke prevention), rituximab (for some cancers), repaglinide (to lower blood glucose) and nelfinavir (used in HIV disease). It's like having to learn an obscure Balkan language while trying to digest a large quantity of live anchovies. These names are bad for our health.
Next, doctors will have to figure out what these drugs advertised to the general public are used for, since our patients seem to know about them well before we do. "Doctor, I'll take some of that Acura." "Er, yes, that'll be for your . . . " If I'm lucky, my patient will accommodate me by informing me about the drug. But my patient may leave me hanging, in which case I will have to pretend that I just got an urgent call from my mother so that I can slip out and look up the medication.
Since none of my prescription reference manuals have yet published information on the drug, I run around madly trying to find someone in the office who can give me an update, and this usually ends up being the janitor. "Ah yes, Acura--that's for ulcers. But don't use it if you have heart problems." As I gratefully go back into the examining room, he calls after me, waving his broom: "And don't forget--it can cause a rash!"
Given that patients will be asking us for medications with names we've never heard of, we have little use for our years of medical training. In the remote past, I enjoyed working in a restaurant, and I find that some of my earlier skills are coming back to me.
MD/waiter: "Yes, sir, is there anything I can do for you today?"
Customer: "I'll have some of your Viagra."
MD/Waiter: "Certainly, sir, one moment please."
If I have any doubts about the appropriateness or safety of the medication requested, I return after a brief absence and say:
"Oh dear, I'm sorry, we're out of Viagra today."
Customer: "Then I'll take the adjustable implant. And could I have it in a box? I'm meeting someone in an hour."
Of course, a little negotiation can go a long way. "Doc, I heard about that Escondida for my high blood pressure."
For a moment I look off dreamily into the distance, thinking about how a California getaway would indeed be excellent treatment for high blood pressure. Naturally, I'm ready with an inexpensive, effective blood pressure medication that I've used for years. I say:
"Why don't we try a little hydrochlorothiazide?"
My patient looks at me like I got my medical degree before they invented the Internet:
"Are you kidding? Just pronouncing that name gives me atherosclerotic plaques." I know I have to think fast or I'm going to lose my patient, who's been coming to the clinic for 30 years. I say:
"Well, I like to call it . . . Innuenda."
Okay, so I made that up, but what's in a name? My patient considers. "Hmmm, Innuenda. I like that." I write the prescription illegibly so no one will notice the difference. And I'm relieved to observe that my patient leaves the office feeling like a million dollars.Caroline Wellbery is a family practice physician on the faculty at Georgetown University.