Marilyn Heins

I have some concerns about relationships between patients and their doctors. Most of us are compliant and do what our doctor prescribes. However, there are two ways patients might react to what their doctor advises or prescribes that could be counterproductive or even harmful.

NOT TAKING ADVICE OR PILLS

This happens when a patient decides to ignore what the doctor recommends or to experiment with dosages of prescribed medications. Some of the smartest people I know do this.

Yes, it’s not easy to lose weight or start an exercise regime when you love to eat and hate the gym. But if you are pre-diabetic, not listening to your doctor can lead to major problems.

Changing one’s lifestyle is hard but it can prevent downstream problems. Check out self-help books and online resources to learn what others have done. Still not on board? Look first at a sunset and then at yourself in the mirror. You want to see future sunsets? Listen to your doctor.

Playing with medications can be almost as harmful as playing with street drugs. Why do people not follow their doctor’s directions? For various reasons. One person may be a bit scatterbrained and forgets to take his pills. Another decides she is no longer depressed so she stops her antidepressant medication. A third goes online and finds just what he is looking for: an excuse to not take the pills because of a rare side effect that he does not exhibit. Still another ignores the directions for properly taking the medication. There is a reason you are told to take the medicine with meals or on an empty stomach.

An enormous amount of research and observation goes into the development of new therapeutic drugs. Drugs are usually tested on mice or other lab animals to ascertain whether the drug is, hopefully, going to work and be safe to take ... in mice.

The next step is to find out whether it will work to cure or alleviate a symptom in people. Controlled studies are done to learn whether the drug does better than a placebo. A placebo has no therapeutic effect so it can be used as a control in testing new drugs. The new medication being studied looks the same but one has the drug to be tested, the other does not. In a double-blind, placebo-controlled clinical trial study, neither the person nor the researchers investigating the drug know which pill is the “real” one. This enables researchers to evaluate both effectiveness and possible side effects.

Studies are also done to learn how well and quickly the drug is absorbed and excreted so that it is known whether to take it on an empty stomach or with food and how many times a day the medication needs to be taken.

If you read the prescription bottle label and the medication sheet the pharmacist hands you, you will be informed about what the research has found. You may complain you are not a doctor or a pharmacist. I am not a lawyer but I read the documents prepared for me and ask questions if necessary. Same thing for prescriptions: read and ask. Both your pharmacist and doctor know more than you know or can learn from an online site.

Think of your body as a water pipe in your house. When something goes wrong you use a plunger. But there are times the clog does not respond to plunging and you must call a plumber who knows more than you do and can fix it for you. You follow the plumber’s directions to keep another clog from happening, right?

What is a prescription drug? A substance that is prescribed by a doctor, bought at a pharmacy, and prescribed for and intended to be used by only one person. It is regulated by the Food and Drug Administration through the New Drug Application process.

An over-the-counter (OTC) medicine, on the other hand, can be purchased without a prescription. Over 80% of us use OTC drugs for minor illnesses. Read the label carefully as it provides the correct dosage and any problems that could occur. Tell your doctor what OTC drugs you are taking.

There are literally thousands of prescription drugs! It is estimated that in 2019, 4.38 billion prescriptions will be filled by US pharmacists. Many of them are used to treat “elder pains” and “elder problems” — 75% of those between 50 and 64 take prescription drugs and 91% of those over 80 do so, including me.

Prescription drugs and doctors, as well as sanitation and other public health measures, are why so many of us octogenarians are alive and functioning. We have to thank the many pharmaceutical and medical researchers who discover or invent new medications, the many universities and government agencies that support this research, and our government that regulates the approval of new drugs and keeps an eye on late side effects.

NOT SPEAKING UP

This occurs when a patient does everything the doctor tells them to do as if they were robots controlled by the doctor’s voice. Sometimes you have to think for yourself and speak up.

I believe in listening to our physicians and following their directions. But I also think we must ask questions such as: “Why is the medication or procedure necessary?” and “Are there any alternatives?” We must also report any side effects if they occur.

I was prescribed medications for a heart arrhythmia. The arrhythmia stopped but my blood pressure fell to the point that I was so weak I could hardly get out of bed. I reported this in a call to the doctor’s nurse. The doctor gave me permission to adjust the medications and arranged for an appointment. Each of us is an individual and may react negatively to a medication. But stopping all the drugs could have been dangerous.

I got the reminder for another mammogram when I was well into my 80s and had never had a problem. I asked my doctor for advice. She asked me what I would do if I had a positive mammogram at my age. I replied I would do nothing. She said she agreed with my decision and added she would feel the same way at my age.

Both not taking your doctor’s advice and not speaking up when you should can be unhealthy, especially for us old folks!

Dr. Heins is a pediatrician, parent, grandparent, columnist, and author. She welcomes your questions about people throughout the life cycle, from birth to great-grandparenthood. Contact her at marilynheins@gmail.com.

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