Why Patients Disregard Prescriptions

Taking just the right amount of medication is rare among patients. Too much or too little is common. This frustrates diligent doctors trying to document effective­ness. It also wastes drugs and diminishes health. Through the eyes of patients, much of the prescrip­tion compli­ance problem falls on the shoulders of physicians. Most doctors reverse the blame. Likely, both are at fault to some degree.

I have respect for the years of selfless training that physicians under­take. Many are over­worked, yet they tirelessly care for patients streaming into waiting rooms day after day. Each comes with a unique problem and a different history. Yet, inside of 10 minutes, a doctor usually offers a prescrip­tion based on past experi­ence and laws of averages—perhaps with the help of a computer. Following up with any adverse side effects is left to the patient.

Past situations shape compliance. I hope my experiences are unique, but would love honest feed­back on how common they may be:

Who’s to Blame?

Preliminary diagnosis: Raynaud’s Phenomenon (unconfirmed)

In my late 20s, a primary-care doctor over-prescribed medica­tions—usually by giving out samples. This kept costs down but circumvented pharmacy alerts. By addressing each symp­tom with 3–5 prescriptions, he had me on over 20 different meds at once. Let me take you through the rationale:

Explaining that cold hands are due to vaso­constric­tion, there is a need for vaso­dila­tors like atenolol, nifedi­pine, nitro­glycerin and high doses of vitamin E. However, this leads to hypo­tension, migraines, stomach irritation and shock. Responding to this with triptans, sucralfate, famotidine, alprazolam, metoclo­pramide and Mylanta leads to more drug interac­tions for which, yes, more drugs, emergency room visits, and hospital admis­sions are necessary.

On one occasion, emergency room personnel were overheard discussing a ban on this doctor. Just as they said, “One of his patients is coming tonight,” I identified myself as the one. Over the decades, this physician’s ignominious career has traversed cities and states with medical disciplinary actions and terminations.

After escalating to cardiologist, neurologist, gastro­enterolo­gist and oncologist referral consulta­tions, the latter broke the unspoken rule of not contra­dicting another doctor and recom­mended that I replace all the medica­tions with a multi­vitamin. In addition to learning not to take every­thing prescribed, I discovered two severe drug allergies and—thanks to emergency personnel—the value of Benadryl.

Preliminary diagnosis: Benign paroxysmal positional vertigo (incorrect)

When reporting to an otolaryngolo­gist a drug reaction to prescribed medication, he became visibly angry since I stopped taking them within the 2-week period between appoint­ments. Scolding me to respect him as the authority and refusing to prescribe an alternative led this office to have one less patient.

Despite voicing apprehension years later, the same drug (now available without prescription) was recommended by a physician’s assistant. The rare reaction of rapid heart­beat and tightness in the chest, occurred again. (Kudos if you can correctly identify the popular drug from these clues.)

After reliving the hour-long trauma in supine position, I more empha­tically refuse this prescrip­tion that has been added to my elec­tronic medical record and the paper medical directive in my wallet.

Preliminary diagnosis: Confluent and reticulated papillomatosis (incorrect)

Following an unsutured punch biopsy with nonspecific results, a dermatolo­gist appeared to type something like “chest spots” into his exam-room diagnosis database and read off the first thing that popped up—a condition affecting most of the torso—not an area the size of a nickel. For this an ineffective $500 ointment was prescribed. The correct cream costs less than 20 bucks.

Miscellaneous allergy-related diagnoses

Three doctors have asked me what drug do I want to try—as if the patient should know in advance. At least four specialists evidently prescribe the same medication to all their patients. One even added, ”More than half of them respond well.” Well good for them, but I am uncom­fort­able with suicide as a side effect.

See: Add Prescriptions to Dementia Causes

A few black-box warning prescriptions and those with ingredi­ents to which I have had prior allergic reactions have been discontinued after depart­ment heads discovered the error. I was simply told the prescribers no longer work for the company and to stop taking the drugs immediately. While looking up side effects for one sample prescrip­tion handed to me by a well-meaning doctor, I discovered it had been recalled. Crisis averted before taking any.

Sample of various pharmaceutical drugs (not prescribed to the author).

Road to Compliance

Mistakes can happen with anyone. But as an apparent lightening rod for botched prescrip­tions, adverse reactions must be my primary reason for non-compliance to varying degrees. I am also apprehen­sive about taking drugs indefinitely—especially when there is no apparent benefit. In my mind, ideal circums­tances for prescrip­tions with compliance looks something like this:

• Evaluate thorough patient history.
• Accurately diagnosis condition.
• Provide easy-to-follow instructions.
• Determine if patient can afford prescription.
• Identify clear path to a favorable outcome.
• Short interval between followup.
• Adjust according to patient reaction.

My current physicians are asked to prescribe as low dose as possible to gauge reaction before increasing dosage. Lists of side effects and contra­indica­tions are studied prior to ingestion. This helps me to identify symptoms that should be alerted to my doctor immediately versus the next office visit.

See: Finally, Affordable Medical Care For All

Recognize that for some ailments, there is no medical cure. Prescribing medica­tions without likely recovery is frustrat­ing and expen­sive. The remedy may require address­ing a change in diet or physical fitness. For chronic pain, patient comfort is most desirable.

See: Should You Take Medical Marijuana?

Online services and apps now allow prescrip­tion price com­pari­sons and coupons. This may not always be helpful when the doctor’s office requests, before you leave, the name of the pharmacy to send the prescrip­tion electronically.

Patients with several prescriptions might benefit from dividing them within daily pill containers. In addition to vitamins, I currently take one pre­scrip­tion at bedtime and another as needed. They do not cure all that ails me but they are affordable, have predict­able side effects, and the steps for compli­ance are simple to follow.

Resilience despite inac­curate prescrip­tions eventually led to sub­contract­ing as a graphics consultant for 17 years with scientists in the claim sub­stan­ti­a­tion depart­ment of a skin-care company that was eventually acquired by a major pharma­­ceutical company. These experi­ences fuel the content within health articles at ClinicalPosters.com.

References

1. Patient Medication Adherence: Measures in Daily Practice. nih.gov
2. Black Box Warnings. lynnwebstermd.com
3. What is GoodRx? How does it work? goodrx.com