Take Your Medicine

There are consequences to ignoring your doctor’s adviceTake Your MedicineIf At First You Don’t Heed Your Doctor’s Advice …Try, Try Again

By Triston V. Sanders

Most of us struggle with some type of health problem, be it obesity, high blood pressure, diabetes or smoking. In most cases, we have the power to fix or improve our situation through diet, exercise, medication or other lifestyle modifications. But because many of us have a tough time changing our habits – or “complying” with what we know is the right thing to do – we are basically killing ourselves. A slow death, perhaps, but virtual suicide for some.

The failure to take medications on time, in the dosages prescribed, is as dangerous and costly as many illnesses. About one-half of the 2 billion prescriptions filled each year are not taken correctly. One-third of patients take all of their medicine, one-third take some, and one-third don’t take any at all.

Studies have shown that noncompliance causes 125,000 deaths annually in the United States. It also leads to between 10 percent and 25 percent of hospital and nursing home admissions and is becoming an international epidemic. It is, in the words of The New York Times, the world’s “other drug problem.”

Dr. Christopher DeLisle of Capital Regional Health Care at SouthWood said there are a number of reasons why patients don’t follow doctor’s orders.

“Many patients are battling a lifetime of habits that started as learned behaviors from their families,” said DeLisle, who is board-certified in family medicine. “So I wouldn’t say that they are resistant to change, but just naturally prone to making some wrong choices. Changing a lifetime of habits isn’t easy, and many aren’t successful the first time they attempt to make lifestyle changes.

As a physician, I understand this may not be possible on the first try and do everything to help and support our patients no matter how many times they have to attempt these changes.

It is the attempt that is successful that really matters.”

One of DeLisle’s patients is 25-year-old Daniel Graham. The men in his family have a history of high triglycerides (the level of fat in blood), which increase a person’s risk of heart attack and stroke. So he asked DeLisle to check – and his levels were off the charts. DeLisle prescribed Graham a medication to help bring his triglyceride levels back down to a healthy number.

Because Graham is a nurse at Capital Regional Medical Center, he knows the importance of taking the medication.

“I see people come in with chest pain on a daily basis, so it’s eye-opening,” he said. “Reality sets in when you find out you are at risk. My condition is a heart attack waiting to happen. I’m 25, and I don’t need to have heart problems at this age. While diet modification and exercise can work in many cases, my levels were so high I needed medicinal intervention. I’ll take medicine the rest of my life, and I’m OK with that.”

In Graham’s case, he has seen success from taking his medication, but many patients aren’t as fortunate. DeLisle said there are myriad reasons why people don’t take their prescriptions.

“As a physician, it is our responsibility to work with our patients to find out the underlying reason why they aren’t taking prescribed medications,” he said. “It could be a host of factors that we know nothing about, such as an individual on a fixed income that can’t afford the co-pay for a specific drug because it is not on their insurance formulary, or a side effect that they can’t tolerate. If the patient has a strong relationship with their primary care provider, asking for a generic substitute for a name brand or seeking a different medication shouldn’t be a problem. Building strong communication between the physician and the patient is critical in avoiding these types of situations.”

Dr. Lorna Stewart is in her third year of residency in Tallahassee Memorial Hospital’s Family Medicine Residency Program and has other ideas about why patients have a hard time doing what is best for their health.

“When it comes to taking medications on a daily basis, it is a hassle,” she said. “Our schedules, whether it is work-related travel, extended meetings or even children, oftentimes do not provide for the convenience of taking pills on regular intervals. It is also difficult to remember to take medications on a daily basis. Most medications are prescribed to prevent health problems and are being given to a person who otherwise feels healthy. As a result, they find it hard to take daily medication when they don’t feel sick. Unfortunately, many health problems are ‘silent killers.’”

“We all have lifestyle things” – even doctors – that can lead to poorer health, said Dr. Tara Wah, an obstetrician/gynecologist who has been practicing for 25 years. She herself was once a smoker.

Wah doesn’t have much patience for patients who continue to smoke during their pregnancies.

“It’s one thing if you want to hurt yourself, but when you’re hurting someone else and it’s my job to take care of that person … I get very frustrated that I’m feeling sort of responsible, but even the mother isn’t feeling responsible enough that she’s willing to stop smoking,” she said.

It’s frustrating, she said, when patients won’t chart their symptoms or follow her advice and then return with the same health problems, saying, “I don’t want to have to do anything myself, I just want you to fix it.”

Lose weight and exercise. That’s the prescription that can cure what ails a lot of Wah’s patients, she advises.

“I don’t have a pill; I don’t have a magic bullet,” she said. “(There are) things that are fixable, but it takes a lot of willpower and time. And I can’t provide either of those for my patients.”

Stewart said that being engaged in a healthy lifestyle is a huge struggle for everyone.

“The big offender here is time,” she said. “Most people are so busy with work, children, family, and life in general, that making time to eat right and exercise regularly is next to impossible. We don’t put ourselves and our health first; therefore, diet and exercise suffer. Also, eating healthy is not convenient. It takes effort and work. Many people don’t see the long-term benefit of a healthy lifestyle; therefore, it is not a top priority. I am here to try and change that.”

Finally, Stewart said, a patient’s relationship with his or her doctor can make a big difference.

“The methods to convince patients to quit harmful habits can widely vary,” she said. “One person who sees a family member suffer with cancer or a stroke may see that as a wake-up call to quit smoking and subsequently quits the next day. Others want to quit but can’t muster the strength to do so. Most people try to quit smoking seven times before they are successful, and it is my job to keep encouraging them to quit and never give up. The majority of people know that smoking is bad for their health; I don’t need to tell them that. I need to support them and educate them, and when they decide they want to quit, I am right there with them.”

DeLisle has a similar take.

“I think that the public needs to understand that seeking help to make major lifestyle changes is an individual’s responsibility, but no one patient or physician is to blame if those changes don’t occur immediately,” he said. “It is essential that a strong partnership between the physician and patient is formed to affect the best possible outcomes for everyone.”

“It makes me sad when I see people doing things that I know are slowly killing them,” Wah said. “I feel like there’s some part of them that wants to die or they wouldn’t be doing that.”

If you’re resisting doing what’s in the best interest of your health, you need to ask why. Next, you need to discuss that honestly with your doctor. Together, try to come up with a strategy that works. If your medicine is too expensive, see if there is a generic version that will be equally effective. If it’s unrealistic to exercise five days a week, try three days to start. If dieting sounds dreadful, come up with a plan that restricts fast food to once a week. Often, it is that all-or-nothing attitude that scares us off altogether.

And whatever course of action is required, consider this: If you do nothing, how can you expect your health to improve? As former U.S. Surgeon General C. Everett Koop once put it, “Drugs don’t work in patients who don’t take them.”

Contributing writer Triston Sanders is a WCTV news anchor. Watch her televised medical segment, “Health Matters,” weekdays on “The Good Morning Show.”