Taking Medication Wisely

Understanding risks and benefits.A recent article bemoans how many people harm their own health by neglecting to take medicine their doctor has prescribed, while another article outlines the risks of taking too many pills. Confused? Don’t be – both things are true. Taking the medication you are prescribed is very important and so is understanding whether you need all the medicines you are taking – or whether you are at risk for harmful drug interactions. That last is a question for your doctor or pharmacist.

Who’s in charge?

As any healthcare provider knows, most factors that contribute to a patient’s wellbeing operate outside of a doctor’s control, in between medical appointments. Doctors can diagnose and treat acute medical problems like an infection, broken bone, or a blocked artery, but when it comes to managing or reversing the chronic conditions many people – including many ICS members – live with day-to-day – heart disease, diabetes, hypertension, obesity – the patient has to do most of the work.

Doctors can prescribe medications and lifestyle changes. They can educate us about our conditions. But despite an entire field of study devoted to getting patients to follow treatment plans (called “patient adherence”), doctors can’t ensure that prescriptions are filled, pills taken as prescribed, diets followed, or exercise programs undertaken. They can’t force anyone to see a specialist, have recommended surgery, or attend physical therapy or a mental health program. They can’t make their patients stop smoking, drinking or abusing themselves with drugs.

All of this is to say that each of us is the most important driver of our health. That’s why ICS Medical Director, Dr. Kwame Kitson, urges patients to be vocal, informed consumers of healthcare, while offering advice on how to get the most out of a medical appointment. And when it comes to medication, asking probing questions and following instructions carefully are equally important.

Understanding risks and benefits

Consider this: According to an April 17 article in The New York Times, studies consistently show that 20 to 30 percent of prescriptions are never filled and that half of all medicine for chronic disease is not taken as prescribed. When people do take the drugs that are prescribed for them, they typically take far less than what they are supposed to.

The results? Not taking medicine properly – or not taking it at all – causes an estimated 125,000 deaths each year and is a primary cause in about ten percent of all hospitalizations. Amazingly, according to research, one-third of kidney transplant patients don’t take the medicine prescribed to keep their bodies from rejecting their new kidneys. And more than 40 percent of heart attack patients don’t take medicine prescribed to keep them from having another heart attack.

So, what gives? Cost can be a factor when patients have high co-payments for medicines. However, even when cost is not an issue, negative attitudes and beliefs about medication play a huge role. Widespread reasons patients and study subjects voice about why they don’t take medication include: “I’m not a pill person,” or that drugs are “not natural,” and “are chemicals.” People also worry about side effects.

Potential side effects, of course, are a valid concern, and something that patients should always ask about. Still, when the “side effect” of not taking a prescribed drug is deteriorating health or even death, rejecting medication is not good self-care – especially if this is done without discussing risks, benefits, or alternatives with a health care provider.

Regarding side effects and drug interactions, another article published last month described growing evidence that taking multiple medications can be dangerous, particularly for older patients, who are most likely to be taking a number of drugs because many of them have more than one chronic health condition. The way to handle this, however, is not to simply stop taking medicine but, again, to have a conversation with your health care provider.

Studies on the potential dangers of taking multiple drugs identified specific risks –falling, an unnecessary hospitalization, or even death – so if you, or a loved one you care for, takes a number of medications, this is certainly an important issue to raise. And careful medication management has real benefits. For example, in studies where patients stopped taking unnecessary or inappropriate drugs, both adverse drug reactions and falls were reduced.

How to take care of yourself

If you think that you, or a loved one you care for, may be taking medications or even supplements that are not needed, don’t wait for your doctor to raise the subject. Walid Gellad, a physician at the Veterans Health Service and University of Pittsburgh School of Medicine was quoted last month saying this: At every visit with a doctor, “patients should ask, ‘Are there any medications that I am on that I don’t need anymore, or that I could try going without?’”

Remember, when it comes to your health, there are no foolish questions, only foolish silence. If you need a little encouragement or a few pointers before your next medical appointment, listen to Dr. Kitson’s podcast, “Communicating with Your Doctor,” right here, on Independence Radio. You can also find this and every podcast from ICS Independence Radio on iTunes now, for free.

 

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