The woman daubed at her red nose and sniffled. She did look miserable.
“Well, after three weeks of green snot it is clear you have a sinus infection. Let me get you an antibiotic.”
She nodded her head in agreement, relieved.
I pulled out my prescription pad and started scribbling. The woman craned her neck to see what I was writing.
“Uh. Doc? I don’t want that antibiotic. It never works. I want something else.” She went on to name the newest, most expensive antibiotic on the market.
My hand froze.
I looked up at her, one eyebrow raised. That was silly. She didn’t need a cannon. She needed a BB gun.
“That is going to cost more than you want to spend. Let’s pick something else.”
“No. The copay for my meds is all the same. I want the best.”
After ten minutes of discussion I had convinced her that what she really wanted was what I wanted and that was a generic antibiotic.
She also wanted me to do a CT of her sinuses. After only one sinus infection per year. After almost yelling at me, she finally agreed to wait and only do it if she didn’t start feeling better in the next two weeks.
She got better without it.
That was ten years ago.
Nowadays the conversation goes something like this:
“Doc, how much is that medication going to cost me?”
“Um. I really don’t know about your specific pharmacy coverage, unfortunately. It is impossible to keep track of the dozens of insurance companies and the hundreds of permutations of coverage in each. But I do try to start with the cheapest medications first. This is generic so you should not have to mortgage the house.”
“Fine. But if it costs more than $10, I’m not getting it.”
“Fair enough. If it is too expensive please call me so we can change things if needed. Meanwhile, I will get the scheduling coordinator to schedule that MRI for your intractable headaches with L sided weakness…”
“Wait, wait, wait, Doc. That is going to be pretty expensive isn’t it?”
“Maybe. I’m sorry. We really need to get it done. I think you might have brain cancer.”
“Tell you what. If I am not better in a month, we can schedule it….”