In the past 30 years, there has been an epidemic rise in both prostate and breast cancer, probably a function partly of excessive hormone intake through our foods, especially meat products. And, these statistics exist despite the fact that we Americans consume nearly 1/3 of all pills that are produced in the entire world. The concept that we are doing well with regard to general healthcare in America is clearly not correct. So, the meeting I had with this patient that morning before rushing off to my suburb offi ce became profoundly important to me. Her care represented many of the issues that plague Ameri- can healthcare. She showed me the problem with our approach to patients who come to us for help. This particular referring physician’s approach was to fi ll a shopping bag with medica- tions from his sample closet, a large number of medications, and tell her to take all those medications and return in a few weeks.
When she returned, feeling worse, instead of stepping
back to reevaluate, he actually gave her more medications and increased dosages. He then asked her to return again in a few weeks for reevaluation.
Because of her fear of disappointing the physician, she did not tell him that she was afraid to take the medications. She did not tell him that despite the bag of free medication, she still was not taking them. Appointment after appointment, she did not admit to him her fear of taking so many medicines. While some may suggest that it was the patient who did wrong and that she is what we call a “noncompliant patient”, this is not my perception at all. I do not believe the patient was at fault, if fault is the proper word, but the responsibility of the referring physician and his approach to healthcare. The successful care of this patient was actually quite easy. All she needed to do was take a controller medication, an inhaler, twice a day to prevent increasing numbers of asthma ex- acerbations. She also needed to hear from me, clearly, that the medication had virtually no side effects in most people and was safe to use even in pregnant women when dosed correctly. Hearing that, alone, gave her tremendous comfort, and al-
layed virtually all of her fears. I noted that she fi rst had to admit her fear so we could face it. She needed to be taught about the meds and their effects. The large number of other medications was unnecessary and she did well without needing to add extra pills or nebulizer solutions. She was also relieved to know that there was a physician who was happy to discuss the condition and medicine side effects. She benefi ted more from the open discussion and open
ears, rather than the prescription and instruction to go to her drugstore. She was happy to know that there would be follow- up care and we would continue the conversation. She would re- turn to the offi ce for a discussion of how this particular regimen was working. There were not several medications added with possible drug-interactions to worry about and to add confusion. A single medication change would be the only variable, and there would be a clear discussion of success or failure within a short period of time to understand whether this medication was helpful or not. Patients always want the assurance that they will have some
follow-up with their physician so as to determine success or fail- ure. No one wants to be given medicines, and then be dismissed without proper follow-up.
Having been in clinical medicine since 1978, and having taking care of thousands of patients both in the hospital and in the offi ce, I have come to certain conclusions about the way I used to practice medicine in our pill oriented society, and the way I practice now. My approach in the past clearly had been to respond to a problem complaint with a prescription. This was my training, this is Western oriented healthcare, and this simply is what doctors do with regard to patient care on a routine basis. It is the rare physician who has no prescription pad on his desk top. I believe that we have been trained this way, and the behavior carries forward over our years of practice.
I am completely amazed at the number of medications we
physicians prescribe in the name of prevention or prophylaxis. It is entirely common to see drug lists of daily and prn (as needed) prescriptions numbering as high as 20 or more medicines. Even trying to take the medicines correctly and on schedule is a daunting task for anyone who is well, let alone for the pa- tient who is ill, elderly, and frequently frightened or confused. Nevertheless, we as physicians frequently choose to maintain a present medication regimen in order not to “rock the boat”. The idea of, “what pill can we do away with?” is frequently not a part of an offi ce visit conversation.
In the next decade, medical treatment and the approach to healthcare will change dramatically. We will be using fewer medications and concentrating much more on illness preven- tion including diet and lifestyle changes. It may be the public and not the healthcare establishment who is pushing hardest for this change. It’s the voice and vote of patient preference which I hear in my offi ce on a daily basis when I take the time to ask. It often sounds like, “Doc, do I really have to take another pill, or are there any alternatives we can discuss? Will things get better if I modify what I’ve been doing out there in the world? Or do I really have to take that pill?” I am glad when they ask. Fortu- nately for us all, times are changing.
Submitted by Michael B. Teiger, MD, FCCP of NEIHA located in West Hartford, CT. For more information, visit
www.neihact.com or call 860.278.3812.
Wildwood Community Acupuncture
wildwoodmedicine.com
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Experience 29
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