October 2007
by Vicki Rackner MD
The older gentleman sitting next to me on the plane said in a confessional tone, "I would really rather not take all this medicine."
This fellow-traveler I'll call Jo had just witnessed me administer CPR during our flight from Seattle to LA to a middle-aged passenger whose heart thankfully restarted. In a very human response to a dramatic event, Jo told me his story.
Jo had been healthy all his life when he suddenly got sick several years ago. He was hospitalized and even spent several days in the ICU. Although his doctors aren't certain, they suspect a virus caused this illness, infecting many organs including Jo's heart. Jo said he was scared he might not survive; fortunately, he made a complete recovery. The doctors prescribed four medications "as an insurance policy" against a recurrence that Jo has taken faithfully for years. Jo said the medical emergency on the plane reminded him that he cannot take his health for granted.
I thought Jo finished telling me his story, so I reached for my book. That’s when Jo mentioned his concern about taking medication.
Jo said, "I don't like taking it. I don’t even know why I’m still on it!"
I asked, "Did you ask the doctors whether stopping is an option?"
Jo replied, "Yes, my doctor says, 'It isn’t doing any harm, so let's just continue.'"
Jo and his doctor may not understand that they define harm in far different ways. For the doctor, harm means impairing the way Jo's body works. For Jo, harm also means impairing the way his life works. Jo says that the medication adds a financial burden, the stress of one more thing to do, and a daily reminder he was sick.
Making a medical choice is like balancing the scales of justice. When considering whether to take a medication or undergo an operation or get a full-body screening CT scan, you weigh the benefits against the risks. One side of the scale holds the possible ways the intervention helps, and the other side holds the potential harm.
Many patients identify with Jo’s position of second-guessing medical choices. This usually happens when patients have not placed all their considerations on the scale.
Here are some factors that you may weigh more heavily than your doctor.
- Cost Even with a good prescription drug plan, Jo pays $15 out-of-pocket for each prescription. That’s $60 a month Jo could be putting into his kids' college fund. In some families this $60 could mean the difference between paying the electric bill or not. Financial concerns lead to stress that can exacerbate the very medical condition the drugs treat.
- Complexity Jo says, "I travel for business. Filling, packing and taking medication is just one more thing to do. Travel disrupts my schedule and I forget doses. Then I feel guilty."
- Self-image Jo says, "I want to think of myself as healthy! That’s hard when I take pills three times a day." Actions and health beliefs are intertwined. Vitamins may work, in part as a daily ritual that says with actions, "I invest in my health." For many, taking medication is a daily affirmation that says, "I am vulnerable to illness."
- Risk Tolerance Jo said, "I can tell my doctor is the kind of guy who plays it safe. I'm more willing to take calculated risks than he is." Each person has a unique perception and tolerance for risk.
Your doctors will not know how treatment affects your life unless you tell them. Most patients are like Jo. They remain silent about the impact of medication on the quality of their lives. The failure of patients to speak up may help explain why only about half of patients take medication as prescribed.
I suggested Jo say to his doctor, "You prescribe the medicine as an insurance policy. We don't know what kind of protection it offers because we don’t even know why I got sick! It costs $60 a month and adds stress to my life. But I pay the biggest price when I look in the mirror and see a sick person who takes lots of pills. I want to go off the medication, and I'm willing to take a calculated risk. What do you think?"
Right now Jo takes the medicine because his doctor tells him to. This new discussion offers both Jo and his doctor a way to put new concerns on the scale. Jo and his doctor may conclude that taking the medication is the best choice. Even if the plan remains the same, it will be different for Jo. He will take the medication because it's his informed choice.
You have an important part in medical decision-making. It can take great courage to tell your doctor what's important to you. Please do it. Ultimately, the best choices for you reflect how treatment affects your body and your life.
Be prepared: carry your medical story
Suddenly there was commotion from the front of the plane. A passenger fell over unconscious on his way to the bathroom. Travelers with medical training offered help. The flight attendant made contact with the pilots who talked to authorities on the ground.
If that passenger were you, would the people coming to your assistance know enough about you to offer you the best care? The care you receive in the moments after a heart attack or stroke could mean the difference between life and death. Access to your medical story is critical when emergencies occur outside of medical facilities.
For the first time in over 20 years of traveling and being a doctor, I helped a passenger who suffered a life-threatening emergency at 30,000 feet. He was traveling alone, and the only things we knew about him were his name and his age from his driver’s license. Fortunately this passenger had a good outcome.
Emergencies, however unlikely, really do happen. Help doctors help you by carrying a card that includes your major medical concerns, names of your medications and contact information. You can either record this information on a blank 3x5 card, or get your own wallet card from my Personal Health Journal. Please do it now!
Dr. Vicki in the news
My thanks to CNN medical correspondent Elizabeth Cohen for the opportunity to contribute to her article "Five must-do's when a loved one is ill." This is part of her "Empowered Patient" series you want to follow at http://www.cnn.com/HEALTH/.
Puget Sound Business Journal
As always, I appreciate the chance to reach business leaders with an op-ed in the Puget Sound Business Journal about the use of generic drugs (9/28/07). You and your loved ones can save money by using generics. Even if your out-of-pocket payment is the same for generics and brand name medication, keep this in mind: We all share the cost of our nation's health care. It's built into the cost of goods and services you buy, the taxes you pay and the medical bills you receive. I believe that the true health care transformation will begin with grass-roots efforts by concerned, empowered people like you. You can and will make smart choices that improve the quality of your health care, attend to your personal needs and lower costs.
Copyright © Vicki Rackner MD, 2007
Making medication choices that work for you