Keywords: Medication adherence, compliance, side effects, physician-patient communication, participatory medicine.
Citation: Graedon J, Graedon T. Why don’t e-patients take their pills? J Participat Med. 2013 Jun 19; 5:e25.
Published: June 19, 2013.
Competing Interests: The authors have declared that no competing interests exist.
Doctors want patients to stay healthy or get better. That’s what patients want, too. They both agree on the goal, but frequently they have different ideas about the best way to reach it.
As many as half of American patients do not take their medications according to their doctors’ orders. Many physicians and pharmacists view this as bad behavior and a waste of resources. A recent viewpoint article in the Journal of the American Medical Association even went so far as to label medication nonadherence “a diagnosable and treatable medical condition.”
Health professionals often feel frustrated or even angry when patients don’t take their medication as prescribed. And patients may feel exasperated when prescribers seemingly ignore complaints about side effects. In many settings, this communication gap leads either to confrontation and finger-wagging, or to patients keeping silent about what they are or are not doing. Neither approach belongs in a participatory medicine encounter.
What’s the Problem?
Doctors and patients may approach a health care concern with different expectations. A blood test that reveals high cholesterol in an otherwise healthy person may not be as serious as the same finding for a person who smokes, has diabetes, or has a family history of heart disease. If the benefits of taking a cholesterol-lowering drug are modest, the risk of side effects (muscle pain and weakness, neuropathy, sexual dysfunction, or memory problems) may loom large for an engaged patient. The doctor may be more focused on the potential benefit.
E-patients today have much more access to information about their medicines. They may even learn from others on the web about side effects that have not yet been recognized in the official prescribing information about a drug. If they suspect that their prescription pills are responsible for a problem, they may decide to stop taking them. One highly informed healthy man confessed recently that he was concerned about some lapses of memory and wondered whether his atorvastatin (Lipitor) was making them worse. He was planning a personal experiment to see if his memory would improve without the medication. In a participatory relationship, he would discuss this experiment with his prescriber, who would be open to learning more about the results of this n of 1 trial.
What’s the Solution?
It is critical for health professionals to be well informed about the latest research on both benefits and hazards of the drugs they are prescribing. Patients care about outcomes that matter: heart attacks, strokes, survival, and how they feel. Numbers on a lab test should not trump quality of life, especially if the evidence is weak that lowering a “risk factor” such as mildly elevated cholesterol or blood pressure will benefit the patient.
It is equally important for prescribers to discuss the most common and most serious complications of drug therapy. They must also honor a patient’s preference to choose lifestyle changes or alternative approaches if these have a potential for success. Encouraging such options rather than dismissing them out of hand can go a long way towards establishing trust.
Patients need to set goals with their health care providers and be accountable for achieving them. If exercise, weight loss, and a DASH diet are not adequate to bring blood pressure into an acceptable range, the e-patient should welcome a discussion about prescription options. If side effects crop up, an e-patient will communicate them promptly to the prescriber and be open to suggestions for other solutions.
It is time to banish the words “adherence” and “compliance” from the medical vocabulary. They are a vestige of an outdated paternalistic practice model that might be termed “doctor knows best.” And medicalizing nonadherence by calling it a “treatable condition” is even worse. The new model of shared information, decision making, and accountability is far more congruent with participatory health.
- Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005; 353(5):487-497. ↩
- Marcum ZA, Sevick MA, Handler SM. Medication nonadherence: a diagnosable and treatable medical condition. JAMA 2013; 309 (220):2105-2106. ↩
Copyright: © 2013 Joe Graedon and Terry Graedon. Published here under license by The Journal of Participatory Medicine. Copyright for this article is retained by the author, with first publication rights granted to the Journal of Participatory Medicine. All journal content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 License. By virtue of their appearance in this open-access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.