Not Taking a Medication – Who Is to Blame?

When I first read the title of this article, I thought this is probably just another attempt to put the blame on patients. However, as I read the blog, I realized that the author actually wanted to shift the onus to the medical system.

The author, Jessie Gruman, speaks rather pointedly when she says, “When clinicians and health systems start to take this issue seriously, such conferences might be useful. Until then, the statistics on non-adherence and efforts to improve our individual behavior are meaningless. Don't bother with the conferences or the interventions.”

The conferences she is talking about are those that the medical community calls to find ideas to force us, the patients, into becoming docile followers of the doctors. They are urging the use of smart pills, smart pill bottles, and mobile apps that will nag us, as our mothers did to make our beds when we were children. Then she says, “Before anyone starts fixing us, try fixing these three things.”

#1. Clinician prescribing skills: I almost roared with laughter when I read this area. It is true that most physicians pay no attention to patient's desires or even explain why we need a medication. They seem to think that we are to follow their orders and not question them about the medication.

We need to know - what the medication is called, what it is for; how to take it, how we'll know if it works, what to do about what side effects, and who to contact for advice about them.  We also need to know if there will be reactions with other medications we are taking.

From a practical standpoint, clinicians should be the starting place for improving medication adherence. If communicating about the appropriate use of medication is not a priority for them, why should using medications as directed be a priority for us?

#2. Medication labels: The pharmaceutical and drug distribution industries are unconcerned that the accompanying printed material requires a twelfth grade education (or higher) and a magnifying glass. Apparently, it is too costly to use a larger box and larger print. Even then, the technical wording often requires a medical dictionary for health literacy.

#3. Pharmacist availability and focus: I am fortunate to live in a state that requires the pharmacist to answer all questions and explain a medication. Do they do this? For the most part, they attempt to comply, but seldom succeed. They make it easy for people to answer no and if a patient comes back later with questions, they say they are busy and seldom answer the questions. I have found that you have to make statements like, this is the law and I did not know what questions to ask when handed the prescription.

A few pharmacists then say that you refused counseling when you picked up your prescription. They have already checked the box on the computer, so technically they feel they can ignore your questions.

Many people are concerned about the lack of privacy and are afraid to ask questions. I will give one elderly woman credit. She was asking questions and the pharmacist was being evasive and using many medical terms. She stopped the pharmacist and said, “Listen sonny, stop the medial gibberish, my son is an inspector for the state pharmacy board in this state and I will inform him of your actions unless you start answering my questions in plain English.'

He continued in his ways and next thing, her son, with the Iowa Pharmacy Board, stepped forward, showed his credentials and locked the pharmacy. He took out papers from his briefcase, completed them, and asked who was in charge. The store manager was called and in turn had to call in the head pharmacist who was on a day off. After she had explained the medication to his mother, the pharmacy was reopened. When the inspector had explained everything to the head pharmacist, he escorted the other pharmacist out of the store.

Yes, we all can have problems in taking our medications as directed, but all of us have in common these three experiences:

1. We don't get complete information from our clinicians about why our medications are important and how to take them over time.
2. Information about use of those medications is incomprehensible and often unavailable (online and off) to many of us.
3. We lack easy and private access to counseling from our busy pharmacist.

The author concludes her blog with this statement. “Fix these, then let's talk about finding out just how big the problem of medication adherence is in this country. That is when efforts can be targeted toward what we can do to make better use of the medications we hope will end our suffering and save our lives.”