iaink

Flu is a virus. This government and others are stockpiling something to treat that, so Im not sure how true that is anymore.

Biiiiink

I said the outcome of your answer to that question is more likely to affect what medication you receive in Canada; as opposed to the UK where price will not make an iota of difference. If the doctor thinks there's an indication for it, you will get it in the UK. A UK GP does not know nor care what the cost to the NHS is. What's best for the GP is if you stabilise and do not use up any further appointment time. Why would they prescribe stuff they think ineffective? Nobody should be on higher levels of medication than they need to be, better to up it slowly than dive on in at a high level and wean you off from there.

Interested that you think "better" = more expensive. As you regularly mention air quality, let's take asthma medication. The expensive stuff is gimmicky pricey dispensers and is extremely heavily-marketed... I have drawers full of goodies with asthma logos from my time in the NHS. Does it mean it's better? How do you know? Have you trawled the journals, analysed the studies, can you be certain your own improvement isn't as a result of the novelty? as someone suffering from whatever disease you can only have narrowband competence relating to your own experience, no matter how much you read on the net or whatever, you can't have the knowledge of your doctor. If you're distrustful of what medication a doctor thinks is appropriate, why not seek a second opinion (as was your right on the NHS), why try and pressure the doctor into giving you the "expensive" (your words not mine) stuff instead? I'll go with proven efficacy not price. I've seen the "placebo" effect and the advertising effect first hand.

I don't know, I'm not a doctor. Perhaps the "something that works" is not indicated for repeated use? Perhaps he was following the protocol for whatever condition? I'm guessing you're talking about regular inhalers vs. steroid based ones... it's never ideal to go straight for the steroids and there are serious long-term issues with those too.

They are. They're clinicians, not businessmen. I'm sure they're not wasteful with handing out unnecessary scripts but if you need it, you get it.

Steve_P

Very true. I'm not sure but I think it is something like a flu shot that will give you the antibodies to fight off the viral infection.

But generally if you show up at your doctors office with the flu they'll tell you to get lots of rest and drink lots of fluids. They won't normally give you a prescription or at least mine wont.

Biiiiink

I'm not convinced. There are prices in the formulary, that's what the NHS will pay for that drug. Not a penny more. The business side is then up to the dispensers - can they get it cheaper, can they make a buck...? I'm sure the figures in the formulary are set at what the NHS can afford on projected prescriptions. Sure, savings can be made - things like tightening up on the handing-out of unnecessary antibiotics (again, this is the patient "bullying" for want of a better word to get something, not an informed clinical opinion)... but if you need it, you get it. I bet there wasn't a conspiracy to put Cowtown on cheap rubbish, it would have been the doctor's genuine belief that that was an appropriate course of treatment for whatever reason.

iaink

Its not the shot, its something called Tamiflu that reduces the impact by a few days. Ours will prescribe it but doesnt usually as by the time you get in to see him the damage is already done and its too late to do much good.

Souvenir

The first time I had cause to see a doctor in Canada, as he got out his prescription pad he asked me if cost was an issue. Nonplussed, I asked him why. It seemed that there were two drugs he could prescribe. One cost about $30; the other about $70 and worked better. Cost wasn't an issue so I went for the expensive option. It didn't work.

Steve_P

Doesn't sound like that's going to do much good in the case of the predicted pandemic.

iaink

My best friend in the UK is a surgeon. From what he tells me, I am convinced.

Are we seriously to believe that a government run body that spends billions on drugs every year has no protocols in place to educate doctors to be aware of the cost of the items they prescribe, and to influence the most cost effective strategy to treat common conditions.

If they dont, then someone is seriously mismanaging things and there bloody well should be a system in place

I guess the thing is in the UK everyone under the NHS has a fair crack at getting what they need eventually regardless of cost, but in canada, those who can afford it can get what they need sooner. Im really not sure which is fairier. The problem with the insurance system is that medical inflation is running riot as everyone want the latest best and most expensive drugs, and doctors prescribe without though for the immediate cost, knowing that insurance will pick up the tab.

It sounds like cowtowns Dr here is more on the ball and just didnt make the mistake of prescribing something that didnt work in the past all over again. Perhaps he had more time here to check records and ask appropriate questions rather than worrying about his waiting list and trying to get to the next patient that bit sooner? Nothing to do with the respective systems perhaps.

Steve_P

It could be that he was giving you a choice between the original drug or the generic equivalent.

My health insurance company will not pay for the original drug if there is a generic equivalent available, unless the prescribing physician can justify it to their satisfaction.

Souvenir

Could be. I didn't have a drug plan at the time though and the doctor knew that.

Biiiiink

There are various clinical guidelines - browse around http://www.nice.org.uk/ if you're interested - but they're just that, guidelines, none of them replace a clinician's knowledge and expertise. I can't say it often enough, if it's warranted, you get it and no GP gives a hoot (or even knows) what it costs.

I really ought not to comment further on how appropriate Cowtown's medication is, even if I knew what it was, I'm not qualified to and neither is he! But it does sound typical of the overtreatment that goes on here and in the US with all things medical/dental though. I blame a combination of advertising to the public, fear of litigation and the promotion of patient to something of an expert. It would have been in his UK GP's interest to give an effective treatment first time that did not eat into further surgery time with repeated return visits and further scripts, hence my belief that the price of whatever was initially prescribed did not enter it one bit, rather it was the doctor's considered opinion of the most appropriate treatment.

Souvenir

Last time I had anything to do with NICE (last century) it had two names. The official one (National Institute for Clinical Excellence) and the one given to it by industry (National Institute for the Control of Expenditure).

Biiiiink

I haven't heard that one!

acer rose

Chances are that if you've made it to the doctor's office, you have not got flu

daft batty

The NHS has to prescribe generic drugs, and source the cheapest they can get. PCTs have great control over expenditure in the NHS.

One of the reasons that antibiotics are no longer handed out like sweets to keep the patient happy is the increasing incidence of MRSA, if we didn't have so many antibiotics then maybe we wouldn't have built up resistance to them.

Does the doctor get paid for writing a prescription??

on a simliar subject, X-ray costs must be expensive in canada as they x-ray more than we do here, and take more views, we take the minimum needed to make a diagnosis and if the request form/clinical indications dont warrant an x-ray then we refuse to do the exam. This doesnt happen in Canada. For instance in Canada 4 views are done routinely of a knee, here its two. Canada, three for an ankle, here its 2. Coincidentally radiologists in Canada are paid by the number of films they report on. I'm not saying its cause and effect but there may well be a link!