Comment by duffpkg | Hacker News Reader

Comment by duffpkg | Hacker News Reader

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The primary cause today of doctors prescribing name brand medications without the ability for substitution of generics is a form of institutional stupidity. EMR prescribing systems are driven by a common "formulary" that has an entry for each drug and defaults. Often the people that define formularies are a weird mix of technological people that don't know anything about the drugs/medicine and medicine people that don't know anything about the technology. The checkbox for the formulary entry that defaults to "allow substititions" is not properly set or is defaulted to disallow them.

Also this reminds me of one of the more evil things I have ever seen in healthcare. Practice Fusion gave doctors a "free EMR" because it was being paid by opiate pharmecuitcal companies to create an electronic EMR workflow that intentionally increased unecessary opiate prescribing. Absolute evil in my opinion.

https://www.justice.gov/usao-vt/pr/electronic-health-records...

> institutional stupidity

If you are a hospital, and you are shopping for an EMR to maximize revenue, is that a feature or is it a bug?

Evil, yes, stupid, no.

I've worked with many, many hospital IT departments as a consultant, contractor, and vendor.

It's absolutely stupidity.

Do you understand that you’re claiming that if the money flow was reversed, the IT departments wouldn’t fix this issue in, say, three years?

Because I have seen many people, and they do the tasks asked of them. They are “stupid” on tasks not prioritized, but their employers are perfectly happy with that.

From a doctor compaining about the difficulties faced by generic alternatives to EpiPens:

If you know anything at all about doctors, you know that they have way too much institutional inertia to change from writing one word on a prescription pad to writing a totally different word on a prescription pad, especially if the second word is almost twice as long, and especially especially if it’s just to do something silly like save a patient money. I have an attending who, whenever we are dealing with anything other than a life-or-death matter, just dismisses it with “Nobody ever died from X”, and I can totally hear him saying “Nobody ever died from paying extra for an adrenaline injector”. So Adrenaclick continues to languish in obscurity.

https://slatestarcodex.com/2016/08/29/reverse-voxsplaining-d...

I thought that most of the time pharmacists were empowered to substitute generics where comparable/available?

I generally have a pretty high opinion of physicians, but they are incredibly overworked, and typically just lazy enough for this quote to be more true than we probably think it should, especially with e.g. 20 years of history writing a specific word for a specific diagnosis.

In this particular case EpiPens are protected from substitutions: https://abcnews.go.com/Health/epipen-users-options-generic-a...

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