Dominican doctors & pharmacy companies [long post]

gringosabroso · #1 06-06-2005, 06:42 PM

I recently had some American, male, mid-life, on-going medical problems; routine & not of emergency natures. I asked about for a local MD of superior reputation; 1 emerged who seemed competent & spoke good English – according to the local Gringo community.
I made an appointment in advance during the week of 30may05 for Mon 6jun05 @ 3:30 PM. Being American, I arrived @ 3:15 PM; there were @ 5 patients & 8 drug sales persons waiting, 5 males, 3 females, all Dominicans, all very well dressed & coiffured, esp. by DR standards. Each carried an over-sized & stuffed briefcase, normal for the pharmaceutical sales profession.
At 3:40, the MD arrives in his now very crowded office; i.e. @ 9 patients & 8 drug salesmen waiting. He admitted each of the drug salespersons to his office, 1 by 1, immediately, each carrying his / her briefcase; each took only @ 5” of his time, then left. All of the [paying] patients, mostly DRs & 2 Gringos, waited.
When all of the drug sales persons had been dispatched, he began to see actual patients; I was called into his office @ 4:25, @ 1 hour late. I politely asked him why I, a Gringo & very well paying patient-to-be, had to wait an hour for my appointment while he entertained drug salesman; he declined to respond. He told me in near perfect English that he recently had to take his mother to Santo Domingo to visit an MD; mother’s appointment was for 9:30; the MD actually saw his mother @ 1:30. He explained to me that I didn’t understand – Monday was traditionally the busiest day of the week in nearly all MD’s offices.
I responded that if Monday was his busiest day, he is aware of that fact, & it might be better to be in the office early to handle the anticipated horde of patients & drug vendors. I thanked him for his courtesy; he was quite polite; I informed him that I needed a different MD & that he would not be happy with me as a patient. I walked out, politely, not rudely.

My questions:
* do all or most MDs take 3 or 4 hour lunch breaks; I imagine this MD left work at 12:00 noon, as most DRs do; this is surmise on my part; he returned @ 3:40, almost 4 hours later.
* Do all drug salesmen visit the offices of MDs on Monday? In the PM? Regularly? For 5” sessions? Why?
* What does a typical MD accomplish with a visiting drug salesperson in 5”? My estimate of the time.
* Is it routine for local, & perhaps foreign, drug wholesalers to pay kick-backs to DR MDs? For the quantity of product pushed onto patients? Is his part of DR medical culture? Food for thought?
* Has any other foreigner had similar experiences with DR MDs? Please share them with us. Thank you.

blondie · #2 06-06-2005, 08:22 PM

Quote:

Originally Posted by gringosabroso

I recently had some American, male, mid-life, on-going medical problems; routine & not of emergency natures. I asked about for a local MD of superior reputation; 1 emerged who seemed competent & spoke good English – according to the local Gringo community.
I made an appointment in advance during the week of 30may05 for Mon 6jun05 @ 3:30 PM. Being American, I arrived @ 3:15 PM; there were @ 5 patients & 8 drug sales persons waiting, 5 males, 3 females, all Dominicans, all very well dressed & coiffured, esp. by DR standards. Each carried an over-sized & stuffed briefcase, normal for the pharmaceutical sales profession.
At 3:40, the MD arrives in his now very crowded office; i.e. @ 9 patients & 8 drug salesmen waiting. He admitted each of the drug salespersons to his office, 1 by 1, immediately, each carrying his / her briefcase; each took only @ 5” of his time, then left. All of the [paying] patients, mostly DRs & 2 Gringos, waited.
When all of the drug sales persons had been dispatched, he began to see actual patients; I was called into his office @ 4:25, @ 1 hour late. I politely asked him why I, a Gringo & very well paying patient-to-be, had to wait an hour for my appointment while he entertained drug salesman; he declined to respond. He told me in near perfect English that he recently had to take his mother to Santo Domingo to visit an MD; mother’s appointment was for 9:30; the MD actually saw his mother @ 1:30. He explained to me that I didn’t understand – Monday was traditionally the busiest day of the week in nearly all MD’s offices.
I responded that if Monday was his busiest day, he is aware of that fact, & it might be better to be in the office early to handle the anticipated horde of patients & drug vendors. I thanked him for his courtesy; he was quite polite; I informed him that I needed a different MD & that he would not be happy with me as a patient. I walked out, politely, not rudely.

My questions:
* do all or most MDs take 3 or 4 hour lunch breaks; I imagine this MD left work at 12:00 noon, as most DRs do; this is surmise on my part; he returned @ 3:40, almost 4 hours later.
* Do all drug salesmen visit the offices of MDs on Monday? In the PM? Regularly? For 5” sessions? Why?
* What does a typical MD accomplish with a visiting drug salesperson in 5”? My estimate of the time.
* Is it routine for local, & perhaps foreign, drug wholesalers to pay kick-backs to DR MDs? For the quantity of product pushed onto patients? Is his part of DR medical culture? Food for thought?
* Has any other foreigner had similar experiences with DR MDs? Please share them with us. Thank you.

I follow your blogs,because i am planning to move to DR, and your blog is a
book of learning. i am a nurse in miami, same here, i know the Drs, i don't go thru the back door of the office, many do,(add 1/2 to 45 more minutes of people that you don't see) + the reps. total waiting time 2 to 3 hours for a 5 to 10 minutes visit, so no difference from here to there, and fyi, the drugs reps give away samples of medications, that in part the Dr share with his/hers patients, and also they "pay" for lectures research studies, and medical reviews, welcome to the world of healthcare everywhere.
blondie RN

MommC · #3 06-06-2005, 10:25 PM

I used to see a specialist and always booked the first app't of the day (1:PM)

Then I would sit in his office while he saw all the emergencies first, then all the referals from out of town (one of the pitfalls of living in the North) then finally ME - usually around 4:45 to 5PM.
I finally started calling his office 15 minutes BEFORE my app't time to ask the receptionist how long a wait I had.

She's tell me then I'd ask her to call me 15 Min. BEFORE he was ready to see me as that's how long it took me to get from MY office to his (I also worked by app't and would lose a half day's pay every time I went to see him which for two years was every two weeks!! That's a whole yr's pay if I had played by HIS schedule!).

Needless to say I was ecstatic when we finally got another specialist in the same field and I made the switch......then I only had to wait 2 hr AFTER my scheduled app't!

GringoCArlos · #4 06-07-2005, 12:56 AM

Sorry Gringosabroso, but most doctors here (Sto Dgo) also have rounds to make, and many in more than one Clinica. I think that most Dr.s I have used may have some appts in the a.m. after they make their morning rounds, and then again at some point in the pm, they make more rounds either before or after their office patients.

Drug reps usually present their target Doctors with information on either one new product that may solve the Dr's patients' problems, or as a new way to treat certain medical conditions that particular Dr may be seeing in his patients..

Most Doctors don't have the time to keep up on what is new in pharmaceuticals in any other way. Reps don't waste Doctors time, or they don't get to see the Dr again. They are problem-solvers, not problem creators.

The drug companies here are not paying kickbacks. If their products solve the Doc's patients problems, guess what - he will continue to prescribe that rep's products for other patients. Samples are a way for the Dr to help some of his patients too, for free.

Being American, I would think that you would be happy to wait only one hour with a scheduled appointment. I don't think I ever saw an American Doctor when I was SUPPOSED to, and they thought nothing about wasting patients' time.

Here in the DR, I usually don't wait more than 10 minutes. When I make an initial appointment with a new doctor, I tell them that I will not wait for the Doc, so when is the BEST time for me to come , and see him right away? I usually end up with a 7:15 am appointment or a 6:30 pm appointment, and this has worked for me.

OHHH.....and one more thing. I have had a few Drs try to charge me a $$Gringo$$ price. It makes matters easier to have a dominican call to make your appointment, and also ask "How much for the visit" = forewarned is forearmed.

planner · #5 06-07-2005, 11:09 AM

I have had the same type of thing happen!!! I always let them know in advance - I pay cash but I will not wait while you see other people with no appointments! My experience has been that having an appointment is not a big deal. Whoever shows up gets in - in the order that they walk in the door!!!

So, I make the appointment, let them know my expectations and if they are not met I tell them clearly I am taking my cash elsewhere!!!

This has applied to Doctors, Dentists, Hair Salons - pretty much anywhere you might need an appointment - or at least want one....

As for the drug reps - I would assume that it is like everywhere, they are flogging their products in whatever way they need to! Free samples, discounts, trips, paying for "education", seminars etc...... Yes they are in and out quickly but they should have to have appointments too....

As in all things in this country, you need to remember who your clients are! A doctors clients are his patients! They should come first. Just MHO.....

Narcosis · #6 06-07-2005, 11:26 AM

If you don't want to wait on a doctor or dentist, best way to avoid this is if you find out before hand if he/she accepts insurance, this will weed out the full waiting room, first come first serve routine.

Some clinics here such as Corazones Unidos in Santo Domingo, cater to non-insurance paying patients and you will generally never have to wait on a doctor there, but it will cost you.

Chirimoya · #7 06-07-2005, 11:33 AM

One of the things that amazed Mr C when he visited the UK, along with the ease of voting, was the way in which you could make an doctor's appointment for say, 8:30, wait no more than 15 minutes, and still get to work at a reasonable time.

That's the state national health system. Here, in the private health system you have to take a morning or an afternoon off work, arrive really early to get on to the 'orden de llegada' list, and wait - often in stifling waiting rooms with unusable toilet facilities - for a good several hours. Even if the doctor is not entertaining medical reps, it is normal for him/her to swan in a good hour after the stated time of arrival.

- having said that, I recently had to have some tests at Herrera (public) hospital and the service, conditions and waiting time compared favourably with most of my experiences of the private health sector here.

carina · #8 06-07-2005, 12:00 PM

Agree, agree, agree...

Not a solution, other than an egoistic one;

- always appointments, either first one in morning or after the siesta, or after closing hours.
- get friends in the needed areas of practice ( as much as possible, some areas we can not assume, but then the other friends will have a friend )

Sounds very egoistic, but helps alot when living here. A huge timesaver!!!

Chirimoya · #9 06-07-2005, 01:17 PM

My solution, seeing as I'm lucky enough to be working in an office that is a five minute walk from my doctor, is to go in early, get myself on the list, go back to the office and call periodically to see how things are progressing, and then go back when the doctor has actually arrived and my turn is imminent.

gringosabroso · #10 06-07-2005, 06:10 PM

I had opportunities to discuss my recent expericnces, all negative, stated in painful detail in the 1st post in this thread with 2 DR nurses.
* Both, speaking seperately, informed me that DR drug comapnies nearly all pay "commissions" to MDs, usually based on the peso volume of the individaul companies' products prescribed by the MD & sold @ local pharmacies to the patients of the specific MD. The MD's secretaries are instructed whom to admit 1st, & who waits, again per 2 Dominican nurses.
* Dare I suggest conflicts of interest? Dare I refer to the Hippocratic Oath?
* If this is true - I welcome comments, including contradictions, on this issue - is it any wonder that the MD in quetions whom I refered to, saw 8 sales people, each for @ 5", before seeing a single patient; there were 9 patients waiting?
* The salesmen pay better! And more regularly! Have I been deceived? Yet again? Am I naive? Was I naive?
* Food for thought: perhaps each of us should ask her / his MD if he has ever accepted "commissions" from any drug companies. Not diplomatic! Of course not! The replies, assuming truthfulnees, might surprise many North Americans. Do any MDs, Dominican or foreign, shose to reply? Food for thought. Thank you.