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Restasis ad (2009)

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Uploaded on Dec 19, 2009

Restasis ad, featuring Dr. Alison Tendler, an ophthalmologist (cataract surgeon practicing in South Dakota) who is compensated for endorsing Allergan's Restasis.

Now before you whine that it's only a 60-second TV spot depicting a doctor/patient encounter, let me say, uh, I know (you DO remember who EyeTV'ed and uploaded it to YouTube, right)?

But if for nothing else, let's use this ad as a "teachable moment" (in the words of BO) to serve as an example of how NOT to conduct a case history. Okie?

First off: if the patient says they're using a drop "several times a day", ya' might want to ask a follow-up question to gain some clarity, e.g.. "Is that two times a day, two times an hour?". Seriously, some people think twice a day IS several times a day.

(And If their response is "2x per day", well sorry, but that's fighting a forest fire with a squirt gun if you're talking treating dry eyes with artificial tears!)

The same goes for the patient's response to, "for how long?" (patient: "quite sometime"). So what exactly does THAT mean? Are we talking months? Years? Minutes? Come on, throw me a bone here!

And to the question, "Have you tried other drops?", the patient says, "All kinds...."

My God, does this patient work for the CIA, where the ability to keep a secret is advantageous ? Or is she a lawyer, where intentional obfuscation is considered a desirable skill? She's a slippery eel, isn't she?

My Dear colleagues, you NEED to follow up with a simple question, even if only, "What drops"? For without knowing what hasn't worked in the past, you're leaving valuable clinical information on the table (and we've all heard the old saying, "those who forget history are doomed to repeat it in Summer School", etc).

Notice how by only 11 seconds into the patient encounter, Dr. Tendler has heard enough to make a conclusive diagnosis: she's already writing a script for Restasis (although she earns extra points by taking an extra 300 ms to UNDERLINE the word Restasis, as if to make sure the pharmacist couldn't miss it (like if it WEREN'T underlined)).

This MUST be a new World Record for quickest time between chief complaint and prescribing, all done without a need to even examine the patient's eyes!

Hint: if you've already started writing the Rx and the patient has to ask, "But Doctor, what do I have"?, that's generally NOT a good sign! You may have forgotten to let the patient in on their treatment plan!

Kind of makes you wonder if the patient had a clue as to WHY she was using "all kinds" of drops for the past "quite sometime", too? Call me crazy, but I find patients tend to do better when they understand WHAT problem they have, and actually 'buy in' on the treatment approach after obtaining a basic understanding of their condition. But hey, that's just ME.

And Dr. Tendler is very lucky if at that point the patient doesn't respond with, "But Doctor, I already tried Restasis, and it didn't work!' (remember the recommendation to get a complete list of meds and therapies that have been attempted, but failed?).

In Dr. Tendler's defense, in the category of honest disclosure she does earn bonus points by mentioning that the patient will be using those 'other drops' LESS, and not eliminating them entirely. In other words, very few patients can rely solely on Restatis 2x per day to alleviate their dryness problems; they'll STILL need to use some other drop, like artificial tears.

Oh, there's just so much more meat on dem' bones, and I could go on for days, e.g. Dr. Tendler's apparent belief that HIPAA privacy laws apply only to her more unattractive colleagues (is she having discussions in the hallway?), or the mysterious lack of her OWN blink reflex (which might help explain her OWN dry eyes? Too much cough syrup? Botox? Mood stabilizers?). I won't mention her reliance on words that most patients don't understand (chronic, inflammation, etc)

I suspect Allergan has genetically-engineered the perfect pitch-person, a robo-doc modeled after the real Dr. Tendler? She cannot be for real....

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