June 11, 2013

Drugs Only Work If You Take Them

The title of this medical blog is one that I can only say “duh” to. Why the authors decide to insult their readers is another question. They even admit that they have educated not to use certain terms, but they were determined to get them in anyhow. I will let you read the terms they used.

If their statistics are correct why do they not state them instead of using generalities. When authors work for one of the premier medical facilities in the United States, you would think the statistics would be available.

I do agree that most people want to follow their health care provider's advice, but there are reasons why many people do not take their medications as prescribed. I will list the problems as the authors see them (in bold) and then make my comments.
  1. We do not understand some of the medical terms and terminology used. For some people this can be a real problem either because of interest, level of education, or distractions around us at the time this is being explained. Health care literacy may also be the problem and even literacy itself.
  2. The patient is not involved in the decision making. This can happen and patients that desire to have a say or involvement simply tune out the doctor at this point (not advisable). This is when the patients need all the diplomacy they can muster to explain to the doctor why they would like to have a part in the decision making process.
  3. Poor communication on the part of the health care provider. This can be a problem especially for doctors that have difficulty in translating to the patient's level and that can't leave the medical talk alone. I do know one doctor that is aware of his own problem and has a RN assistant that translates for him and does an excellent job of it. Many doctors will not acknowledge this and patients go away wondering what they had just heard.
  4. Your doctor has an incomplete medical history on you. This unfortunately happens all too often. Many people just figure that this is just old information and the doctor does not need to know this. Wake up people, this may be the missing piece that explains why something is happening or even not happening because of a prior illness. An example is chicken pox. Once you have had chicken pox, as you become older, shingles becomes a real possibility and is several times more painful than chicken pox ever was. The chicken pox virus remains part of you once you have had it and something can reactivate the virus and you now have shingles. Little bits of supposedly unimportant information can solve a lot of medical problems.
  5. Limited finances or access to health care. This can be a very sensitive issue for some. For others they are not afraid to ask for help. In some rural areas, transportation can be a problem especially with the cost of gas. This is an area that too often the doctor or his staff often could care less about as long as the bill is paid. The efficiency is misplaced when these people are involved. In this case, they take the care out of health care.
  6. The patient has complex medication regimens. This could also include complex medical problems, but either can be very stressful for the patient and sometimes confusing in keeping all the medications straight.
  7. The patient may have cultural barriers, memory issues, health beliefs and other issues. These are often overlooked by doctors and their staff, but need to be investigated. The patient also has a responsibility to inform the office about these, but sometimes they forget as well.

This can be a complex issue with a variety of solutions. The authors list the following possible interventions. I don't like this term and would think the term patient investments would be mean a better outcome and the patient would feel more like they were being valued.

Some possible interventions include:
  • Patient-education classes
  • Providing interpreters for foreign speaking individuals
  • Simplified medication programs
  • Empowering people to self-manage chronic diseases
  • Written instructions or pictures specific to a person's literacy level
  • Provider consideration of economic constraints
  • Appropriate follow-up care”

Now whether these are only for the health care provider or the patient can assist in some of them is dependent on the area. Interpreters is something that patients could do for themselves. Patients do need to consider learning and taking a more active role in their care. Often they have never been taught the skills even to make this possible and they innocently think everything needs to be done for them.

This makes it more difficult to assist them and give them the skills they need. They do need to be taught to ask questions, but they don't know where to begin. This is when you need to ask them if they have someone that could help and then you work with them together.

For other people, they may just need to be encouraged and shown how to ask questions and learn about their medical condition and the program they need to follow. Consider telling them to invite a family member or friend to their appointments, to assist with understanding instructions.

There are many aids that may be used and the staff of most offices should have a list to give to patients and where they may be acquired.

Another area that is often overlooked is the pharmacist.  Most, but not all, will take the extra time with a patient to explain the different medications and the importance of each.  They can also reinforce what the physician has said and even make a list of when each should be taken.  I have queried my pharmacist when I have seen studies advising switching from AM to PM and the reverse.  In one case the pharmacist said I was reading the study correctly and if it was not for another medication I am taking, she would recommend my switching.  Under the circumstances and the medication, she could not let it happen and advised me accordingly.  She did say to let her know if I was taken off that medication and she would revisit the issue.

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