“Your Health Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive.
Order Dr. Zipes’ books, Ari’s Spoon, a new novel, as well as Bear’s Promise and Damn the Naysayers, A Doctor’s Memoir. Check out his website at dougzipes.com.
Being a physician has been a joyful but demanding endeavor, perhaps more challenging now than ever before. Patients armed with the latest information gleaned from social media sources often confront doctors with misinformation they’ve just read about. Doctors are stressed keeping up with medical advances that increase exponentially, doubling the amount of new knowledge every 2-3 months. The business of medicine requires many hours of paperwork, stealing time from direct patient interactions. Artificial intelligence may help with that burden but creates its own challenges.
Despite some negatives, the fulfillment of relieving someone’s pain and disability, and saving lives, is a blessing and cannot be matched by any other profession. It is perhaps best crystalized in the advice attributed to Dr. Francis Weld Peabody in a lecture to Harvard Medical School students almost 100 years ago: “…the secret of the care of the patient is in caring for the patient.”
To care for patients properly requires their cooperation. For example, when a physician gives a patient a prescription for a particular medication, the doctor expects the patient to take the medication as prescribed. Many patients do not, with medication nonadherence occurring half the time in the management of chronic conditions such as diabetes or high blood pressure. Nonadherence to prescribed treatment is thought to cause an estimated 125,000 preventable deaths and $100 billion in preventable medical costs per year.
The reasons are multiple and include fear of potential side effects experienced personally or observed in others; cost; misunderstanding about the drug, its importance, or how to take it; taking too many medications; lack of symptoms (we cannot make an asymptomatic patient less symptomatic, but often medications are taken to prevent future symptoms); mistrust frequently due to misrepresentation of facts about the disease or medication; concern about becoming dependent on the medication; and depression. Some patients may have cognitive impairment, drug or alcohol use, cultural issues, or alternate belief systems that counter taking prescribed drugs.
Improving medication adherence is the responsibility of both the physician and the patient. The doctor needs to explain about the drug, how to take it, reasons for taking it, and why the benefits outweigh the risks. The patient needs to raise any concerns not discussed by the doctor. Cost is often an issue, and it’s maddening to witness drug companies raise the price of some medications with profit as the only justification. Physicians often are not aware of the cost of the drug they recommend, but if brought to their attention, a less expensive form of the drug may be available, often in a generic form at more reasonable prices.
Taking a medication over many days or longer requires a change in behavior, and that is difficult for many to incorporate into busy lives. While Peabody was right, ultimately the care of a patient is a partnership between the physician and the patient. The physician promises to diagnose and treat, while the patient promises to follow the treatment advice. If either one fails to fulfill their promise, disability and death can follow.
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