One of the interesting things about sitting at the "switch" of a publication charged with covering all of ophthalmology, rather than a focused subspecialty, is the occasional juxtaposition of seemingly disparate messages. On its face, we have such an occurrence this month; on further consideration, not so much.
On the one hand, we have a new pharmaceutical entry in the field, whose purpose is to enhance eyelash growth. In the process of meeting that need, of course, you can enhance your bottom line (p. 32). On the other, we have a review of the challenges glaucoma patients and their physicians face in the thorny issues of cost and insurance coverage and their proper place in the physician's recommendation for medical treatment (p. 78).
Before anyone gets into a letter-writing dudgeon, I'm not equating the significance of eyelash growth with IOP control. (The great irony, of course, is that in each case, we're talking about glaucoma drugs. Isn't yours a wonderful profession!)
The juxtaposition in this case, between spending hundreds of dollars for eyelash growth and scraping together enough to pay for beta-blockers, "yesterday's drug," rests on the idea of meeting patient needs.
A 2004 survey of elderly patients with chronic diseases in Archives of Internal Medicine reported that two-thirds never told a doctor or nurse in advance that they planned to underuse their medications because of their cost; 35 percent never discussed the issue of drug cost at all; and two-thirds reported that they had not been asked by their health care provider about their ability to pay for prescriptions. A 2006 American Journal of Managed Care study found that for one third of newly prescribed medications, physicians discussed an aspect of acquisition, including cost and insurance coverage, in just 12 percent of cases, and logistics of obtaining medications in 18 percent.
Now whether you want to devote precious chair time to such discussions as the ability to pay is doubtful. In the case of glaucoma drugs, it's pretty well established that ability to pay may have a major role in the success or failure of treatment, so that directly effects your decision-making. Eyelashes may be another story, but until you ask, you don't know. The point is, whether it's the physician or someone else, it might be a good idea to have a person in the practice whose responsibilities include identifying unasked questions that walk out the door.
