Monday, March 19, 2012
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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 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.
- 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.