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Saturday, January 22, 2011

She'd said Yes: Adverse drug events from a desire to please the doctor

Dr. Jeffrey Schnipper's story:
A Spanish-speaking woman came in to our hospital with very high blood pressure. She was on six different medications for it, she said, so we put her on a regimen of medications that was close to that, and that bottomed out her blood pressure! (I see something like that at least once a year.) This must have been the first time her body was actually seeing all those meds. I'd asked her in my Spanish – I'm pretty fluent – and she'd said Yes, she had really been taking all of them. I asked our hospital pharmacist to contact her community pharmacy, at Walgreen's in town, and we realized that one of the meds, she hadn't been taking for two months. Another one, she hadn't been taking for four months. A third medication, she was taking about two-thirds of the time (in other words, she was filling a 30-day prescription on average every 45 days). One medication prescription had never been filled at all. The two most costly medications, she HAD been taking faithfully. When we asked her again about her medications, showing her what we now knew, she admitted that she couldn't always afford her medications, so didn't fill all the prescriptions on time. She admitted to occasionally forgetting to take them. She also admitted that she didn't really know which medications were for her blood pressure. Each time she had gone back to her primary care provider with poorly controlled high blood pressure, her doctor had added another medication to her regimen.

She really needed TWO medications, IF she'd actually take them. So we backed off to two or three, choosing once a day, relatively inexpensive medications, which controlled her blood pressure really well. We also gave her a pill box and a refill reminder calendar to help her remember to take her medications and refill her prescriptions on time.

Advice: Tell your doctors the truth; don't tell them what you think they want to hear. If you have a problem with drugs being too costly, having side effects, occasionally missing doses, or you can't get to the pharmacy, tell them, and hopefully they can work out something that suits you better.

Read another story on a patient’s non-compliance.

Thanks to Dr. Jeffrey Schnipper for the source interview.

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