CRANQUISVILLE, USA – The Affordable Care Act of 2010 brought many changes to the US healthcare (insurance) system, and doctors have already felt the impact in many ways – in their finances, their reputations, their blood pressure readings and their prescriptions. One component of the ACA in particular, the Physician Payment Sunshine Act, essentially severed the long-cherished symbiotic relationship between drug company representatives (drug reps) and prescribing physicians.  Now, 4 years later, one doctor is finally seeing the effects of this heinous governmental intervention: he’s running out of drug pens.

doctor prescribing
No clue what I should prescribe now

“The ink is drying up!  The springs are wearing out!” lamented Dr. Ebenezer Cranquis as he tenderly caressed a fat-barreled green-on-white pen with a faded “Nasonex” printed on it.  “I’ve had this beauty since 2007, and it’s just… just wasting away.”

“As a med student, drug pens were, hands DOWN, the biggest perk and status symbol around,” recalls the urgent care physician.  “You’d come back from a noon conference with, like, 5 fat yellow-and-pink Levaquin ballpoints in your white-coat pocket, and your classmates who skipped conference would be SO jealous!  I turned down my share of hot med school girls begging for my drug pens back in the day, I’ll tell you what.”

When word came down that drug companies were going to stop handing out pens (or anything else labeled with their products’ names), Dr. Cranquis, along with many other US physicians, stocked up: “Things got pretty wild there for a bit.  Drug rep visits almost caused riots, doctors and nurses pushing and shoving to snatch the pens, med students weeping as they pawed through the piles of discarded magnets and paperweights. Reminded me of the great Tamiflu shortage of ’09.”

Now as the last few pens die out, an unexpected consequence is popping up: doctors are forgetting what to prescribe to their patients.

“It’s embarrassing,” says Dr. Cranquis.  “There I am, with some patient yakking away about post-nasal drip or something, and I’ll subtly glance down at my breast pocket to pick a drug name at random, as I always did.  But nowadays, my pocket usually has black unlabeled pens in it – I mainly keep my precious Nasonex and Neurontin pens stored in the locked narc cabinet.  That’s when the horror hits me all over again: Why oh why didn’t I pay attention in pharmacology class?”

“It’s not fair!  How can anyone expect me to actually ‘choose the right drug’ if there’s no highly-suggestive pseudo-hypnotic brightly-colored drug-labeled pens close at hand to prompt my choice?  Hell, the whole reason they banned the drug rep merchandise was because they KNEW we docs couldn’t possibly make these kinds of decisions on our own!  They gave us crutches, now they’re taking them away!  What am I supposed to do, now: ‘Listen to the patient’?  ‘Use my experience and knowledge to decide what drug may provide more benefit than harm’?  ‘Try to convince the patient that NO drug is even needed in the first place’?!  Ain’t nobody got time for that!

Dr. Cranquis is a contributor but is better known for his Tumblr blog: “I’m an American physician who works in an Urgent Care clinic. I see lots of stupid or funny things that people do with-and-to their health. I cope by mumbling under my breath (and then posting about it on this pseudonymous blog). Thought you might be interested. “