What Communication Does and Does Not Do

This is a classic case of poor communication and then excellent communication. This is based on a true experience of a relative, but names are withheld at his request.

The doctor did not explain the possible side effects or instruct the patient to call if he experienced any of them. Statins that are prescribed are often just handed to the patient with no explanation. Many doctors are very sure of their abilities and figure that the patient should just follow orders.

Then when the patient starts experiencing muscle pain, he is surprised and either stops taking the statin or heads for the computer and looks up the side effects and stops taking the statin. Some profanity is said about the doctor and the patient says nothing to the doctor.

The lack of communication continues at the next appointment and the doctor asks why his bad cholesterol (LDL) is still elevated. The patient says he does not know. Therefore, the doctor prescribes a stronger dose of that statin. This time the patient decides to talk with his pharmacist. The pharmacist asks if there has been any muscle problems and the patient says yes.

The pharmacist asks if he used any other pharmacies and the patient said no. The pharmacist asks if the patient is still taking a certain medication and the patient answers yes. The pharmacist says she will call the doctor's office as he should not be taking but 10 mg of the statin to avoid problems with that medication. When she hangs up with the doctor, she says the doctor had gone ballistic and would not give the lower dose. She said he was to stop the other medication, but she could not recommend that.

Patient asks what he is to do. Pharmacist asks if he would see another doctor. Patient asks if this doctor knows how to communicate with patients. That he does the pharmacist says and dials the phone. When she hangs up, she says the doctor will see him in 30 minutes on the second floor in this building. The pharmacist then says to wait a few minutes and she will print off a list of the medications that he is taking and side effects of each and conflicts with other medications.

The pharmacist then has a copy for the doctor and discusses them with the patient. The patient is now enthused about seeing the new doctor and happy with the pharmacist.

When the patient completes the paperwork and meets the new doctor, the patient is surprised at the amount of time the doctor spends reviewing his records. The doctor then discusses the medical history with the patient and covers the medications the patient is currently taking. He then calls the pharmacist and asks her two questions and writes three prescriptions for the patient, and then discusses each with the patient.

The patient asks a few questions and the doctor explains that he will have a blood draw before leaving and another appointment in four weeks with a blood draw before that appointment. This will tell them the status under the current medications and what changes occur in the four weeks for possible needed perscription changes. The patient is told if any of the side effects that they have discussed are noticed, the patient is to call the office immediately, and hands him a card with the phone number and his name on it.

The doctor hands him a two sheets for the blood work and asks if he has more questions. The patient says maybe by the next appointment as he was going on the internet to do some reading. The doctor asks if the patient has an email address and then asks for it saying he would send him an email with an internet listing of reliable sources and at his next appointment, they would set the patient up with a patient portal to his records and secure email to ask questions of the staff.

After the blood draw, the patient goes to the pharmacy. The pharmacist fills the prescriptions and also covers the side effects. She asks if the doctor had covered these and instructed him to call if any developed. The patient says yes, and thanks the pharmacist.

The second example is what should happen, but seldom does. The first doctor wonders why his patients are not taking their medications, but figures he is better off without non-compliant patients. The second doctor knows what happens and makes sure he covers side effects and explains them to the patient. The second doctor also instructs the patient what to do if he experiences any side effects.

The second doctor also asks about dietary supplements and looks for problems and this is the doctor we all need, but often cannot locate. Therefore, we have work at training our doctor and talking very carefully with our pharmacist.