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Not Following the Doctor's Orders
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Monday, March 19, 2012
Jenna Spivak
Online Communications and
Social Media Coordinator
Please Note: The content found
on this Blog is for informational
purposes only. It should not be
a substitute for professional
medical advice, diagnosis, or
treatment. If you have any
questions regarding a personal
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always ask your physician.
Never ignore medical advice or
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All Blog posts are reviewed and
approved by the physician cited
in the article, as well as by
Steven J. Davidson, MD, Chief
Medical Informatics Officer
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I have to admit that sometimes I’m not a model patient. About a year ago, I was training for my first half marathon when I started to feel pain in my right knee accompanied by an audible ‘clicking.’ I went to Dr. Howard Goodman, Orthopedic Surgeon at Maimonides Medical Center. He told me that my knee didn’t completely sit in the joint, sliding out of place every now and then, which caused my discomfort. Dr. Goodman referred me to a physical therapist, assuring me that it was a simple fix.
Miraculously, the next day I woke up with no pain. After I ran my half marathon pain-free, I decided I didn’t need to see a physical therapist at all. Since then, however, I’ve run three half marathons and countless other races and my knee has started to act up again. I complained to my mom, who’s a nurse, and told her that my injury had come back. When she asked if I had ever gone to physical therapy, I hesitantly told her no. She scolded me saying “Jenna, just because the pain’s gone doesn’t mean the problem’s gone.”
I knew she was right, so I begrudgingly went to see Dr. Goodman again. I confessed that I had not followed his recommendation and that I was worried I may have made my injury worse. Fortunately, there was no additional harm, but this whole experience got me thinking about patients – like me – who don’t always follow doctors’ instructions, even though we know it will help. Noncompliance is actually a widespread and very expensive issue. According to the Healthcare Intelligence Network, patient noncompliance costs US health systems around $290 billion every year. And, patients are putting their lives at risk – 125,000 Americans are dying annually due to poor medication adherence.
Physicians, pharmacists and researchers are trying to come up with creative ways to combat this problem. Tools, such as mobile apps or pillboxes with alarms, can alert patients when it’s time to take their medication. Strides have been made in pharmaceutical technology, offering a more Asimovian approach. An American drug company plans to launch a pill with an digestible microchip, allowing physicians and caregivers to monitor when a patient takes his or her medication. A different pharmaceutical company recently produced an implantable microchip-based device that delivers precise doses of medication via wireless communication. Personally, I think these pharmaceutical approaches are a little too invasive, and I wonder if they’ll actually become viable options.
While these new technologies focus on the problem of ‘forgetfulness,’ I spoke to Dr. Alan Hilfer, Chief Psychologist at Maimonides, about patient motivation (or lack thereof). “There's always ambivalence when taking medication,” states Dr. Hilfer. “Even if a person needs it, no one wants to take it.” Due to potential side effects and stigmas, many people feel wary of taking medicine. “Another problem occurs when people start to feel the beneficial effects of their medication,” notes Dr. Hilfer. “They think they’re getting better, so they believe that they don’t need to continue taking the prescription.” When you combine other factors, such as treatment costs and how time-intensive it may be, it’s understandable why some patients don’t follow their doctor’s orders.
For me, I didn’t go to physical therapy for several reasons:
- I felt better. Why did I need to get help when I was no longer in pain?
- It was inconvenient. It would take an additional hour out of my already limited free time.
- It was expensive. A $20 copay? Each session? No thanks.
I didn’t forget to go – I chose not to go. So, instead of focusing on how microchips can aid in patient compliance, I think researchers and government officials could find success by tackling the not-so-easy-to-solve issues of cost, time and motivation. |
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Tuesday, May 01, 2012 by Lei
Hey.I'm a 100% non synthetically-medicated psctioyhc kid. Diagnosed schizophrenic and have very serious positive symptoms and equally horrible negative symptoms. Here is what I do to keep on top of the depression that is one of my negative symptoms.1) Omega 3 Fish Oil. You may have to buy a brand manufactured for kids because adult brands don't tend to be filtered for mercury and you DEFINITELY want a mercury-free product. 2) Multi-vitamins. Take something with a very high iron, vitamin D and magnesium.3) Exercise. If you're overweight, a healthier bodyweight will help you out. If you're not, exercise will still release endorphins. Personally when I'm at my worst I do yoga from flashcards, (this is when I cannot leave the house) boxing, and jumping jacks while a music channel (usually rock but I figure anything with a good beat that you like listening to when you're happy will work) is on. I also go running, when I'm not as bad, usually in a forest on warm days or at a beach on cold days, somewhere where I'll be alone with nature and my ipod. 4) Music. I mentioned the music channel & ipod above, but I also blare Queen, Bowling for Soup, Blink-182 and the All-American Rejects (aka nobody who sings about death, depression, suicide, sadness, or has a downbeat - less than 4/4 - track) and I HATE IT. It makes me MAD and MAD is better than depressed. It is more productive. ;]5) I force myself to do things I enjoy when I'm happy. I take a shower with the nice smelling soap and warm my towels on the radiator, I watch the funny episodes of Firefly and my favourite films and read magazines and This Book Will Save Your Life (A.M Homes - it's my favourite book). And if that sucks, I do the laundry and hoover. For me what works is just keeping moving. Then even if my whole day sucks and I can't bear it, the next day I can wake up to something good I've done and maybe feel better for it - or I have fond memories of my favourite movie etc.6) My favourite one - I read a book I've written. It's a big old book that I bought ages ago and when I'm happy, I write things I like in the book. Stupid stuff like, Xander from Buffy, and the sound from line arrays, and Diamond 4's, and sherbert lemons, and Harry Potter 1, and Gandhi quotes, things that have no consequence. If I'm only mildly down, it can get me back up.7) Meditation. Just sit quietly and concentrate on not concentrating on anything. If that makes sense. Don't allow yourself to have thoughts. Let your only thought be the thought that stops you thinking about anything. It sounds complex but you probably get my meaning. I like to meditate either in the dark in my room but the sunlight is good for depression so I force myself to sit in the middle of the living room with all the shades open in the sunlight. Therapy. Not from a councillor - from a psychologist, in particular a psychologist who is a qualified Cognitive Behavioural Therapist - these people are like GOLDDUST. They will teach you how to get through your worst moments and help you tailor your recovery techniques to your own personality. Plus, they're also usually really cool not-up-themselves people. Interview a few different psych's if you can, and if they're in an office and wearing a suit, don't bother. Find someone who wears jeans and listens to the music you like and likes the TV shows you like, so you geniunely like their company and that way, you'll get a lot more out of your time with them - it'll be more friendly and less clinical. And that in itself will lift your mood.Please bear in mind that the most important thing to have to get over depression without meds is psychological resilience. You need to be the type of depressed person who says, this sucks, but I WILL GET THROUGH THIS. I WILL NOT GIVE UP.. I WILL FORCE MYSELF THROUGH THIS. If you're prone to giving up (I am not saying this is something to be ashamed of, it's just something to be honest about - I understand fully that being a can't-be-f*cking-bothered/don't-want-to-can't-make-me depressive is horrific and not something the depressive can help) you may have to come to terms with the fact that you may need a low dosage of meds (Citalopram is good in low doses) to get you through, and you may have to rely more heavily on therapy. Either way, get a CBT and remember you are not alone, and you should never give up on yourself.'When all you've got to keep is strong, move along. And even when your hope is gone, move along.'Good luck. Was this answer helpful?
Monday, April 02, 2012 by Jenna Spivak
Hello Patrick,
Although I'm not sure why your physician prescribed a particular medication, I can only trust that if your doctor prescribed it and a pharmacy dispensed it, the medication was necessary to treat you. It's important to realize that all medications have side effects and can potentially result in complications. For example, aspirin - which many consider to be harmless - can worsen asthma in some patients.
It's crucial to find a doctor (or multiple doctors) with whom you feel comfortable and trust. It's also important to discuss any health conditions or ailments of which he or she might not be aware. Prescribed medication can react in unintended ways due to certain medical complications, current prescriptions and daily nutritional supplements. If your physician is fully informed, he or she will be able to make the best decision regarding your care.
If you have any questions or concerns about a specific medication, speak to your physician or pharmacist.
Sunday, April 01, 2012 by patrick stefanelli
why would a doctor prescribe a medication with a black box warning and the medication is a type 2 medication called metaformin doctors know this medication can lead to death causing lactic acid buildup is the medication worth the risks doctor did not tell me this had this side effect yes i dont listen to doctors all the time pharmacies and doctors all about money
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