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[IP] pump question concerning possible doctor's commissions



While doing a residency in the early '90s, our department was frequently 
 visited by the pharmaceutical detail reps. One particular company would take
our
 department on a chartered fishing trip each year. That same company supplied us
with samples that were used personally by the attendings.
  One Friday night when I was on call, I admitted a diabetic patient with an 
infection. I completed the appropriate history and physical work-up, including 
drug allergy history and Gram stain, and placed this patient (who had never 
been admitted to a hospital) on a cheap but generally effective IV antibiotic 
in the penicillin family.
  When I presented the admission to the attending on Monday morning I was 
instructed to change the IV antibiotic order from the cheap penicillin to the 
very expensive antibiotic 'X' that was (of course) made by the company that 
sponsored our annual fishing trip.
  Having the results of the culture and sensitivity, seeing that the 
 patient's bug was susceptible to the cheap drug, and given the fact that the
patient's
clinical presentation had improved over the weekend, I asked the attending to 
explain why we needed to change antibiotic. Of course I challenged every 
reason that the attending gave for changing the antibiotic.
  After a heated discussion I said that if the attending thought the 
 antibiotic needed to be changed she/he would have to go upstairs and change the
order
herself/himself because I wasn't going to do it. In my less-than-humble 
opinion there was no clinical indication to change drug. I got sent home for 
insubordination and the patient's order was ultimately changed to expensive 
antibiotic 'X' by one of the other residents.

  I'm no longer in a clinic setting and this happened over a decade ago, but 
I have no doubt that the same sort of thing still goes on.....

  At the time I got my pump my endo's office stated that their experience was 
primarily with a particular brand of pump, but that the choice of pump was up 
to me. I respect the way they handled the situation. I selected a pump that 
was not their 'preferred' brand at the time, but they have been supportive of 
me and my pump all along.
  I say - do what you think is right and be sure that you're comfortable 
looking at yourself in the mirror each morning...

Happy pumping,
Margaret
Type I x 15 years, pumping exactly 1 year tomorrow!
.
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