Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Thursday, January 30, 2014


I've posted a fair amount about Big Pharma, and how they market drugs they know to be ineffective, or even unsafe, how they buy off doctors to be Key Opinion Leaders, or just active prescribers of their drugs.
And I've been smugly patting myself on the back for not using drug pens or post-its, etc. But not quite. When I meet with a new patient, I tend to take notes. And since I don't have a chart yet for that patient, I use a clipboard with plain, looseleaf paper. I don't pay much attention to the clipboard, because I've been using it so long I don't even notice it. How long? Since residency. I know this because it's a Zyprexa clipboard, and I haven't gotten stuff from drug reps since I was a resident.

Sorry for the crappy photo, but it's some pretty glaring advertising, no? I don't understand what the little dude at the bottom is supposed to symbolize.

Is it a big deal that I use a zyprexa clipboard? I don't know. I feel like I should be more cognizant of what it might mean to patients. Does it make them think I'm going to throw an antipsychotic at them? That I get lots of stuff from drug reps?

Regardless of what it means to my patients, I think there's something to the fact that it's insinuated itself so thoroughly into my work life that I don't notice it anymore. It seems broadly emblematic of the situation with drug companies. They're part of our thinking. They're just there, no questioning required. Of course I use a Zyprexa clipboard, who doesn't use all that cool, free stuff the drug reps give away?

I decided to make my own symbolic gesture, and get rid of it. But I do need a clipboard. I can probably dig up some old thing at home, but I thought I'd get a really fun clipboard, to make up for my loss.

And this is it:

the hold-tight

Lime Green Clipboard

From Poppin. Set me back all of $5, a small price to pay for ejecting Big Pharma from my office.

While I was at it, I decided to get some fun office stuff:

the cut-above

White Scissors

This pair will beat rock and paper every time.

the most-writeous

White Letter Size Writing Pads

the write-away

Bikini Medium Spiral Notebook

the always-on-point

White Retractable Gel Luxe Pen

The clipboard is simple and perfectly functional. The scissors work well and have white blades. The paper is dense and has a nice hand. The notebook is cheerful. And the pens are cool-looking but write scratchily.

And not only is Poppin not paying me to write this, but they don't even know I exist. Which is good, because that way they can't target their marketing at me, like the Lilly rep who gave me the Zyprexa clipboard.


  1. Gel Pens are the best writing instruments ever made. I use the Pilot G-2s in all black, red, and blue in all widths but usually the 10. Whenever anyone borrows it - they can believe how the writing feels in their hand. The only downside is leakage if you fail to retract the tip. That can result in some damage to clothes and furniture but worth the risk.

    No conflict of interest. I personally buy them all. Wish they would sell more refill cartridges.

    Try them.

    1. It's funny, but I've been using nothing but the Pilot G-2s for years. I think they write better than the Poppin retractibles, but they're not spectacular-I used to use a Pelican fountain pen so I'm spoiled-and the Poppins take generic gel replacements, so when the ink runs out, I'll order some Pilot refills. Plus the Poppins look so cool.

  2. I too use a clipboard with plain, looseleaf paper for initial evaluations. I bought myself a simple, clear plastic clipboard when I started practice about 20 years ago. Not a bad return on a $5 investment.

    How big a deal it is to use a Zyprexa clipboard? To some extent it depends on the patient. Many won't care or notice, others may think it crass or unprofessional to wave around a glaring advertisement. I suspect it influences our self-image as well. We're not primarily purveyors of products even if that's the way Pharma (and some patients) prefer to see us. Displaying product brands essentially says we're a supplier of those brands. Even though I write prescriptions, prescription-writing is not how I identify myself or my role. My professional identity leads me to avoid branded bling, and conversely avoiding branded bling reminds me of my professional identity. At least that's how I see it.

  3. As a patient who has been on psych meds for more than 40 years, I can say that the clipboard would be a huge red flag to me. I would definitely feel that the meds you prescribed me were influenced by big pharma and were not necessarily the best ones for me. I would also shake my head at your naivete that you think something like this would not affect a sophisticated psych patient.

    That being said, I have to say that I have benefited over the years from the starter packs in my doc's closet. When I was much younger, I depended on them since I was broke and uninsured.

  4. I think it does matter if we have drug co swag so I'm with you in getting rid of it. It has been years and years since I took anything from a drug rep. I wish I had had the sense to refuse it from day one but we learn.

    1. I remember thinking, when I was a resident, "We work horrible hours for lousy pay. Drug co. swag and dinners and lunches and textbooks are the only perks we get. And isn't it nice that these companies want to give something back, unlike insurance companies. And our meds have to come from somewhere, so..." Yeh, we learn.