Sunday, November 1, 2015
Jerry Kill walked away from head coach at the University of Minnesota football team because he could no longer balance the demands of the job with the treatments required for controlling his seizures. The side effects of his medications made it difficult for him to function. He changed the way he took his pills, even against medical advice, but still was unable to find the balance that he needed in his life and football had to go.
The patient doctor relationship is supposed to be a partnership, but too often it fails. With face-to-face time decreasing, a doctor’s visit has become more about filling out forms and writing prescriptions than about actually visiting with the patient, talking together and learning about the patient’s wants and needs. For that reason, a big hole has developed in medical care, which costs hundreds of thousands of lives every year.
Compliance describes a patient passively following their doctor’s advice to manage a chromic health condition. Adherence is the term used by the World Health, where doctors and patients team up to help the patient actively engage in maintaining their health. Pick a term! Patients tend not to take their medications as prescribed and the price can be deadly. Up to 40% of nursing home admissions are a result of poor compliance and 125,000 deaths per year are attributed to people not taking their medications as directed.
Surveys repeatedly reveal that up to 75% of people who are prescribed medication for high blood pressure or high cholesterol, admit to not always taking their pills as directed. People have a hard time taking drugs when it might take decades to see the positive results of not having a heart attack or stroke from high blood pressure, or not going blind and needing dialysis from diabetes.
There are plenty of reasons that patients give when asked about their compliance/adherence. Too often though, the doctor doesn’t know, because the question wasn’t asked or because the patient doesn’t tell. Either way, the opportunity to impact the health of the patient is lost. Think about a few barriers:
- The prescription’s price or its co-pay is too expensive. Often there are alternative options. Most doctors don’t know the price of the prescriptions they write, but many drugs cost less than $10 for a month’s supply. However, that may not be the solution. Studies show that compliance increases only by about 5% when patients are given their medications for free.
- The side effects interfere with life. Diuretics, or water pills, are one of the mainstays of high blood pressure (hypertension) treatment and they make people need to go to the bathroom. It’s inconvenient and most people take the pills in the morning because who wants to get up in the middle of the night? Some medications cause nausea and indigestion; some headaches and others weight gain. Blood thinners make you bruise, have nosebleeds or worse. Nothing comes without a potential cost, but again, there are potential alternatives and the goal of a medication is to maximize benefit and minimize side effect.
- The directions are too confusing. Drugs dare not one-size fits all. Some need to be taken with food; some on an empty stomach. One a day, twice a day, more often? There may need to be routine blood tests to check the medications level in the body. But there are people out there to help. If it’s too inconvenient to talk to the doctor or the nurse, a local pharmacist may be a useful resource. But most providers presume that if questions aren’t asked, that the patient understands what’s going on. Often the patient does not but also does not feel comfortable asking.
There are myriad other obstacles that get in the way of the chain of events that should happen. The prescription is written: the patient gets the medications; the patient takes it as directed. But perhaps the most important barrier is that the patient questions their doctor’s advice or does not believe that the medications will work.
Studies show that patients rely on their doctor’s advice only a little more than half the time. Instead they seek to validate that advice with friends and family, or from the internet (If it’s on the internet, it must be true). Patients want more knowledge but they want it in a form that they can understand. Almost half the time, they do not understand the information provided by their doctor about their illness or medication…and the average time spent discussing that medication? 49 seconds.
It should come as no surprise that Jerry Kill decided to adjust his seizure medication regimen. He could not tolerate the side effects; it affected his family life and ultimately his ability to do the job that he loved. His story is not an isolated one; it is just the public face of what happens every day in medicine. In our attempts to streamline the practice of medicine, we have forgotten that the key to success in providing care is having the doctor and patient sit and visit, to talk and learn from each other. But who has time for that.This entry was tagged adherence, compliance, Jerry Kill, medications, seizures