Thursday, April 5, 2007

Maybe I Won't Take My Meds

Recently, Rita Rubin of the USA Today did a nice piece on the issue of patient compliance; specifically why they not take their medications. Here is the link:

http://news.aol.com/partners/usa-today/_a/medicine-not-taken-falls-into-sickly-web/20070329103009990001

The reasons patients don't take their medications are summarized below:

1. side-effects
2. memory
3. depression
4. beliefs
5. cost


Personally, I think there are some other reasons as well. One of my medical partners think patients just come to us for reassurance. She also thinks that doctors need to be good salespeople and many of us are not. We need to SELL them on why they need to use it. The last reason not mentioned in the story, however, may be the strongest. It is my opinion that people will not take medication long if the disease they are taking them for does NOT give them symptoms. In other words, they will take their pain medication. They will take their GERD medication. They will take their angina medication. Hypertension, high cholesterol and osteoporosis give no symptoms and I will guarantee they are the most common drugs people stop taking.

Any other thoughts? What do you think of the doctors as salespeople concept?

9 comments:

Sanya said...

I think the subject gets put back into the box with the patient and the doctor do not spend enough time discussing the patient's health issues. Then there is the economic warfare among pharmaceutical companies that out and out tell the patients that some product is worthless or causes death. Then there are those of us who were born believing that if it ain't broke, don't fix it. Prevention is unproveable. It is the lie that medical bean counters would like everyone to believe. Prevention is marketable to every one because every one fits in a category of some kind of susceptibility to disease or accident. I went 53 years without a broken arm until I was conned into chasing my dog under my treadmill that was neatly folded away in my living room. I conked my head so hard I fell backward and landed on my left arm and I was not even trying to break my fall. It was carpet for heaven's sake. I have no doubt that the osteporosis medication would have prevented my arm from breaking, but my jaw might have been crushed from osteonecrosis of the jawbone. Cholesterol preventatives, prevent savings accounts, and lectures from doctors. They cause all kinds of side effects that makes you wish you would have a heart attack and just get it over with. My opinion is if it ain't broke don't fix it, if it is broke, discuss with your doctor if it is worth fixing or do you need a new one. If the side effects of the treatment cause more pain than the disease, we have something to discuss.

Anonymous said...

Dr. Doug,

You forgot some other reasons:

* Well, my husband took this medicine and HE broke out in an itchy rash (I actually have asked the patient, "So, are you and your husband related?")

* My friend said that she read on the internet that this drug rots your liver and kills people. Even though I've been on it for the past seven years, I stopped it right away when she told me that...

* I decided to stop my blood pressure medicines after I heard from my barber that all I have to do is to take this colon-cleansing tonic made from all-natural herbal roots and oils from Antarctica. It costs me $250 per month on-line, but it's worth it! (BP=190/110)

* Pills? What pills? I ain't never taken no pills before in my life! (But Mr. Smith, don't you remember we talked all about your diabetes three months ago?) Baaaah. I don't got no $#@!! diabetes!! No 'A1C' or whatever of 8.5% don't mean sh#@!

* Well, I figured I'd try diet and exercise for a few months longer to get my cholesterol down. (But Mr. Smith, you're 68, your cholesterol is 380, and your COPD and CHF aren't really going to allow you to exercise that much.)

________________________

Building a relationship of trust with patients improves compliance some, but alas, like the ER doc told me in residency, "Ya can't fix stupid."

Anonymous said...

Denial. If I don't take my daily medication(a daily reminder), I don't have an illness. See how simple this is!

Anonymous said...

I'm an RN, and I think that MDs, like the RNs, don't have the TIME to do a dog-and-pony show to make patients take their meds. It would be nice, but I race from patient to patient on my Med-Surg floor, passing meds and charting so that Jcaho and my manager to get up my butt for not charting "patient education". (How to I have time to educate when I have to chart every time the patient picks their nose?)

I see the MDs running, too, and they don't have time for this, either. Maybe in a different world, but not now.

Anonymous said...

Another issue with medical compliance is drive. It doesn't seem normal for some to need a medication. That is the reason for the patch movement. Soon, we will probably see more people esconced in patches, because it's easier to change a patch once a week or month, than to take a daily med.
That said, because of the donut hole, my patients and even my mother would rather do without meds than to pay the exhorbitant costs. I can obtain some replacements for my mother through samples, but no matter how much education I do, when I look in her medicine cabinet, they have not bee touched. She just needs somethng to complain about, though.

Anonymous said...

The RN hit it on the nose they don't have time to educate. So it is up to an intelligent patient to formed advocate for themselves. I noted this past year two very low cholesterol checkups. Since I started a healthy diet recently I explained to my GP That I was not going to take my cholesterol meds for the next 3 months. If I see a change for the worse at the end of that timeI will go back on it. If not I will continue to monitor it and clue my GP in. I wanted to do this with my BP meds too. My BP was very low 110/60 and I wanted to do the same on a two week trial for this.....sure enough after two weeks and doing pressure checks I found it had gone up 134/84...so I put myself back on the BP meds. I think monitoring by an informed patient who works with the medical team taking care of them is good. I may be wrong but I feel I am in charge of me and as much as I respect the medical team they are rushed and busy. BUT I must say I do this with their full knowledge. Not wise any other way.

Anonymous said...

Hi annonymous!
The RN WAS right. Oh, by the way, did you go to nursing school, med school,PA, or pharmacy school to make an "informed" decision?

lipitor said...

companies marketing mineral makeups and also get the best bargains in mineral makeup you can imagine,
find aout how to consolidate your students loans or just how to lower your actual rates.,
looking for breast enlargements? in Rochester,
homeopathy for eczema learn about it.,
Allergies, information about lipitor,
save big with great bargains in mineral makeup,

change edition interviewing motivational people preparing second
,

interviewing motivational people preparing second time
,

interviewing people motivational preparing for a second time
,

black mold exposure
,

black mold exposure symptoms
,

black mold symptoms of exposure
,

free job interview questions
,

free job interview answers
,

interview answers to get a job
,

lookfor hair styles for fine thin hair
,

search hair styles for fine thin hair
,

hair styles for fine thin hair
,

beach resort in the philippines
,

great beach resort in the philippines
,

luxury beach resort in the philippines
,
iron garden gates, here,
iron garden gates,
wrought iron garden gates
, here
,
wrought iron garden gates
,
You: The Owner's Manual: An Insider's Guide to the Body That Will Make You Healthier and Younger
,
answer from more much,
eat eating mindless more than think we we why
,
la times classified,
new york times classified


texturizer,
texturizers here,
black hair texturizer,
find aout how care curly hair,
find about how to care curly hair,
care curly hair,
lipitor rash,
lipitor reactions,
new house ventura california,
the house new houston tx,
new house washington dc,
new house washington dc,
new house ventura california,
the house new houston tx,
the house new houston tx, that you ar looking for,
new house ventura california, you need to buy,
new house washington dc,

hair surgery transplant
,

air filter allergy
,

refurbished dell laptop computers
,

hair surgery transplant
,

air filter allergy
,

refurbished dell laptop computers
,

hair surgery transplant
,

air filter allergy
,

refurbished dell laptop computers
,

chocolate esophagus heartburn study
,

chocolate esophagus heartburn study
be informed,

digestion healing healthy heartburn natural preventing way
,

digestion healing healthy heartburn natural preventing way
,


Allergies, lipitor rash,
alcohol rash,
lipitor and alcohol,
lipitor alcohol,

natural remedies to aid healing of esophagus
,

chicory heartburn
,

effectiveness of zocor vs. lipitor
,

chocolate esophagus
,
southwestern wrought iron yard gate,
exterior iron gates,
oriental wrought iron gates,
powder coated iron garden fencing,

hoof prints said...

black mold exposure,black mold symptoms of exposure,wrought iron garden gates,your next iron garden gates, here,hair styles for fine thin hair,search hair styles for fine thin hair,night vision binoculars,buy, night vision binoculars,lipitor reactions,lipitor reactions,luxury beach resort in the philippines,beach resort in the philippines,homeopathy for baby eczema.,homeopathy for baby eczema.,save big with great mineral makeup bargains,companies marketing mineral makeups,prodam iphone praha,Apple prodam iphone praha,iphone clone cect manual,manual for iphone clone cect,fero 52 binoculars night vision,fero 52 night vision,best night vision binoculars,buy, best night vision binoculars,computer programs to make photo albums,computer programs, make photo albums,free printable tax forms,printable tax forms, free here,craftmatic adjustable air bedcraftmatic adjustable air bed, info hereboyd night air bedboyd night air bed, low priceair bed in wisconsinbest air beds in wisconsincloud air inflatable bedbest cloud air inflatable bedsportable sealy air bedportables, sealy air bedsaluminum rv luggage racksaluminum made, rv luggage racksair bed form raisedbest air beds form raisedsupport equipments aircraftbest support equipments for aircraftsinformercials bed airbest, informercials bed airmattress sized air bedsbest mattress sized air bedantique doorknob identificationantique doorknob, identification tipstroubleshooting dvd playertroubleshooting with the dvd playerflat panel television lcd versus plasmaflat panel television, lcd versus plasma pic the bestcauses of economic recessionwhat are the causes of economic recessionbed air foam adjustablebed air adjustable foam hoof prints antique and unusual equestrian printshoof prints, antique equestrian printsbuy adjustable air bedbuy the best adjustable air bedsair bedscanadian storesair beds, cheap canadian stores