Compliance Follow-Up

Today I learned something new.  In the discussion of my most recent cross-post on KevinMD, Dr. Steven Reznick says:

In most patient – physician visits I have seen in my 30 plus years of practice  the physician identifies a problem and tries to explain it to the patient in lay terms. The physician then outlines the choices and options for treatment and will say which one he/she prefers. The risks and benefits of the choice are discussed. In most cases the physician and or staff access the patients drug plan to make sure what is being prescribed is covered by the patients insurance. Most practitioners ask the patient if they have any questions or concerns before the visit is complete.  Once the patient leaves without raising a question or concern , as the physician you assume the patient is going to follow the mutually agreed upon care plan. You also assume that if there is a problem with the plan after the patient leaves, they will call you, stop back in the office or set up another visit to address their concerns. You do not expect the patient to not fill the prescription or not take it and then show up at a follow-up appointment to check on the efficacy of the treatment only to find out they have not taken the medication at all. It clearly is a two way street communication between physician and patient. If a patient believes a medication is causing an adverse effect or if they want to stop the medication for other reasons it is reasonable to assume that the patient will contact the prescribing physician to discuss the options and choices including how to safely eliminate the medicine .  These options are explained at most visits, they are written in practice instruction books and welcome to the office manuals, they are placed on practice web sites… 

I honestly have never heard this.  In fact, I think I’ve heard the opposite.  Don’t call!  Two different times I have called about a prescription that wasn’t working for me:

Growing up, it was hammered into me that you always finish a prescription.  Always.  That lesson stuck with me.  In college once when I got sick enough that I thought I should see a doctor, I went to the student health clinic.  A prescription was written.  Always finish the prescription became a problem because when I took the first dose, my neck turned red and my throat swelled up, making it difficult to breathe.  Benadryl and time helped.  Thinking perhaps the problem was something other than the medicine, I took a second dose later.  Oops.  Obviously, this was a prescription I wouldn’t be able to finish.  I phoned the clinic and the doctor said, as if I was an idiot, “Well, quit taking it then!”  My follow-up question was whether I needed a different prescription to replace it, or if she needed to see me again. The doctor told me that wouldn’t be necessary.  I was stunned.  Why had she written a prescription if I didn’t need one?  It really sounded like I should have just quit taking it on my own and not bothered her.

The other time I had a severe reaction to a medication, I called the doctor’s office.  The receptionist didn’t want to hear about it and gave me the nurse’s voice-mail.  She didn’t call back.  I called again just before the office closed and left another message, miffed that I was being ignored but resigned to not getting a call until the next day.  Still no call.  The third day I called again.  The receptionist said that my call should have been returned (ya’ think?!), and she put me through to the nurse’s voice-mail once again.  Finally, much later, the nurse phoned and said that if I wouldn’t take the medicine that caused vertigo & vomiting, then they’d write a prescription for the medicine that makes my throat swell; those were my choices.  I chose to go without.  Six weeks later, at my follow-up appointment, I specifically asked, “My understanding from the medication insert is that I’m supposed to call you if I experience an adverse reaction to the medicine, but you wouldn’t take my call.  Under what circumstances should I phone you between appointments?”  The response was, “Never!  There would never be any reason for you to call between appointments.”

Twice I’ve called about prescriptions.  Twice I’ve been blown off.  Given this history, it is not reasonable to assume that I’ll be making any attempt to phone a doctor about a prescription.  Unless specifically instructed otherwise, my inclination would be to figure things out on my own and take it up with the doctor at my next appointment.

Dr. Reznick’s comment makes me think that perhaps I should phone my podiatrist about those ridiculous Flector patches he prescribed.  That prescription was Plan B; after a trip to the pharmacy, I made the choice to go with Plan A instead.  I really thought it would be okay to just mention that at my next follow-up appointment.  Now I wonder.

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8 thoughts on “Compliance Follow-Up

  1. Many years ago, before I was diagnosed with RA, I went to a doctor for a severe case of exzema. In addition to a topical cream, I was also prescribed some pills. When I took the first pill the following day, I immediately broke out into hives and had difficulty breathing. Mind you I’ve never presented signs of allergies to a medication before or after, and as luck would have it the pill I was allergic to was anti-allergy medication! I called the doctor right away to inform him that I was going to stop taking the pills until my follow-up visit, and was floored by his response. He told me to continue to take the medication, as there was no way I could possibly be allergic to it.

    Needless to say, I did not resume taking the medication…and I never did return for the follow-up visit.

    So I agree, the best thing to do is call right away and communicate with the doctor, but is seems that all too often we receive either an inadequate response, or a response of annoyance.

  2. I was amazed at all the comments your compliance post received on KevinMD. Very interesting. My experience has sadly been along the lines of that which you described here. It amazes me that many doctors (even patients) believe this is a rare occurrence, if it happens at all. It took me years to find a competent internist and rheumatologist. Perhaps these people haven’t been that ill. I don’t know.

    What I do know is that I put myself through the ringer questioning myself as to why no health care professional would return my call? why wouldn’t doctors answer my questions? I didn’t know I could have a say about my treatment! And if I questioned anything the doctor said, I was quickly chided for it. I’m not just talking about a couple of doctors either.

  3. I have lots of problems with this issue of compliance. I don’t go to doctors often, but when I do, it’s because I want a diagnosis. For example, I once had a very sore throat. I wanted to determine whether or not it was Strep, and if it was, I was prepared to take antibiotics. I saw a doctor at an urgent care, had a throat culture which determined that I did not have strep. As I prepared to leave, the doctor wrote me a prescription for antibiotics anyway. I told him that I would not be filling it. He said, “Let me tell you why you must…”

    However, I was not open to his attempt at persuasion (and putting it in those terms was probably the worst approach to take with me). I didn’t fill the rescription. My sore throat went away just fine on its own.

  4. If the doctor wont listen to the patient about side effects or allergy it is time to go to another doctor. I call when I need to especially since I have ended up in the er caused by a severe reaction to Humeria. My husband reacted so badly to a medicine he was in he ended up with blood clots that resulted in a week stay in the hospital.

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