Medications: Conversation with Dr. Rice
Patients Deciding Whether Or Not To Take Medications
I was talking with my mom recently about someone we both know who was helped by the anti-inflammatory drug prednisone, but did not take it because she felt it made her hair thin out. Even though prednisone is a widely used drug with well-documented effects which do not include marked effects on hair growth. She did not talk with her prescriber or pharmacist; just stopped taking an effective medications.
Patients have their personal priorities when it comes to considering the benefits of treating disease and acceptable medications effect. These priorities allow patients to make personal judgments about what drugs are “worth taking”.
As a pharmacist-in-training, I heard stories years ago about cancer patients who declined their opioid medications for pain because the drugs caused constipation. The message being that bowel regularity can be more important to patients than pain, or that constipation is more to be avoided than cancer pain. If we are going to treat patients well, we need to consider preventing and managing constipation in all patients receiving opioid drugs; that is standard practice now.
Think about medications and side effects, and what you’re willing to put up with.
It will likely vary by disease state and depend on the length of treatment. Many patients with cancer often put up with all sorts of undesirable treatment effects; life is on the line and cure is often possible.
To lose your hair, feel miserable and vomit following treatment can be normal occurrences with some cancer therapies. If treatment is likely to be successful, there is goal in sight and the fight against cancer is on. You can win when the treatment ends and the adverse drug effects go away.
For other cancer patients who feel that treatment will not be successful, palliative care is aimed at minimizing disease symptoms and unwanted drug effects to provide quality time with family and friends.
Medications and treatments that have an end in sight are easier for patients to tolerate.
If you have an infection with a fever and feel miserable, then a touch of diarrhea with your antibiotic is just part of feeling a little bad on the way to feeling a lot better.
Treatments that do not have an end in sight are tougher on patients.
- Consider treatment for hypertension or cholesterol.
- Patients cannot feel either high blood pressure or high cholesterol and are typically treated for life.
- The consequences of either disease process can be decades away.
- Undesired effects, which might include low blood pressure and dizziness, or muscle pain and weakness, are modest compared to cancer chemotherapy.
- But patients can be reluctant to take medications that make them feel bad today for a benefit that can be years to decades away, even though treatment is the right thing to do.
Your pharmacist should be asking you – and you should be asking your pharmacist – about your medications. When returning for a refill, I usually ask my patients a simple, “is this a good medicine for you?” and “what concerns do you have about your medications?”.
It used to surprise me how often there’d be some uncertainty about medications, or something interesting that a patient noticed. Many patients are thinking interesting thoughts or wondering something about their medications.
Pharmacists practicing in 2016 are more highly trained than ever. It’s good for patients and good for pharmacy when patients take their medications as prescribed and pharmacists solve any drug-related problems that arise.
Talk to your pharmacist if you have any concerns about your medications. Take care of your health!
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