What Do Patients Know About Their Medications?

Physicians have great responsibility to protect the health of their patients. But the practice of medicine is a shared responsibility. Patients – the major stakeholders – obviously have responsibility for their own health. In my view, they are charged with questioning and understanding the rationale of proposed medical advice. I do my best to explain my advice clearly. If there are reasonable alternatives, then I present them. But if the patient before me remains unclear on the situation, then he needs to ask me to repeat and clarify. Patients must exercise personal responsibility.

If a surgeon enters an exam room and tells you that surgery is scheduled for the following morning, I would hope that you would be fully informed on what operation is planned and why it is necessary. It sounds absurd that a patient would consent to an unspecified surgery.

"Ready for pot luck surgery tomorrow?"

And yet, I regularly see patients who have no idea why they are taking certain medicines. (I admit that many of their medication lists are so long, that they would need to carry an Excel spreadsheet with them to keep track!) I don’t expect patients to know the chemical structure of their medicines, but I do think that they should know their general purpose.

A few days prior to penning this, I saw a patient taking Eliquis, a potent blood thinner. This medicine was of interest to me as it would need to be temporarily held before his upcoming colonoscopy. It wasn’t clear to me from his chart why he required a blood thinning agent, so I resorted to a time-tested method to find the truth. I asked him.

He wasn’t sure why he was taking the medicine. It was prescribed a year ago by his orthopedist at the time of hip surgery to prevent a blood clot, a complication that he thankfully avoided. In this situation, the blood thinner is usually prescribed as a temporary measure. I thought that there were 2 explanations to this puzzling situation.

Through medical oversight, he was never advised to stop the blood thinner.
The patient needs the blood thinner for another reason not known by him.

I directed him to contact his primary care physician for clarification. He did so and contacted me back as I requested to explain that he did, in fact, have a cardiac condition that warranted this drug.

So, no foul, but, why didn’t he know this? Did the doctor fail to inform him? Did the patient simply forget? Regardless of where the blame lies, this patient should have known why he was swallowing down a chemical each day. Look over your own medication list. Can you explain the medical necessity for each one of them? If not, might I suggest a time-tested method to find the truth? Ask your doctor.

Comments

Becoming a Part-Time Physician

Next month my schedule will change. I will henceforth be off on Fridays with my work week truncated to Monday through Thursday. I am excited to be enjoying a long weekend every weekend. And while the schedule change is relatively minor, this event does feel like an important career moment for me. It is the first step on a journey that will ultimately lead beyond my professional career. It is this recognition that makes this modest schedule modification more significant than one would think it deserves. As some readers know, my current employed position has been a dream job for me. Prior to this, I was in a small private practice, which I loved, but was much more challenging professionally and personally. My partner and I ran the business. Working nights, weekends and holidays were routine for decades. On an on-call night, if I slept through until morning, I felt as if I had won the lottery. And w...

When Should Doctors Retire?

I am asked with some regularity whether I am aiming to retire in the near term. Years ago, I never received such inquiries. Why now? Might it be because my coiffure and goatee – although finely-manicured – has long entered the gray area? Could it be because many other even younger physicians have given up their stethoscopes for lives of leisure? (Hopefully, my inquiring patients are not suspecting me of professional performance lapses!) Interestingly, a nurse in my office recently approached me and asked me sotto voce that she heard I was retiring. “Interesting,” I remarked. Since I was unaware of this retirement news, I asked her when would be my last day at work. I have no idea where this erroneous rumor originated from. I requested that my nurse-friend contact her flawed intel source and set him or her straight. Retirement might seem tempting to me as I have so many other interests. Indeed, reading and ...

A Patient's Loyalty to his Doctor

A few days before preparing this post, I greeted a patient who was about to undergo her 5 th colonoscopy. I was the pilot for the 4 prior excursions. “You should’ve signed up for the rewards program,” I quipped. “This one would’ve been free!” Our patients, with rare exceptions, enjoy our light atmosphere seasoned with some humor. This does not detract from our seriousness of purpose and commitment to their welfare, and they know it. Our endoscopy team is comprised of outstanding medical professionals. I care for many patients for whom I have performed all of their colonoscopies, which may exceed 10 procedures. I recently performed an examination on one of my colitis patients who has unique findings which have remained stable for years. I know his colon as well as I know his face! Indeed, if I were shown a photo of his colon, I would immediately be able to name the individual. So, when we gastroenterologists c...

MD Whistleblower

Search This Blog