“That New Medicine You Prescribed…”

Three days ago I wrote about a patient who stopped his old medicine when he started a new one, while I had intended for him to take both. That episode made me think about how I communicate medication adjustments.

Well, I saw two patients yesterday who should have called me about problems with their medications. I don’t understand why they didn’t.

Samuel, a diabetic with both neuropathy and sciatica came in to follow up on his new prescription of duloxetine two weeks earlier.

“That new medicine you prescribed – I took my first one and soon after I was on the flush with the waste basket between my knees blowing out both ends of me. Never took another one.”

“And here we are, two weeks later. I never heard that you had a problem with it. If I had known, I would have suggested something different for you earlier. There are many options. Do you dare to try something different?”

He did, and I made very sure he knew to let me know if he had any worse side effects besides the typical ones I described.

Tristan was three weeks into his topiramate titration. I always start with 25 mg at bedtime the first week, twice a day the second and one in the morning plus two at night the third. Then I follow up in person to see how effective the medication is.

“That stuff”, he said, “is giving me these terrible headaches. I can’t take any more of it.”

“Did you get it even with just the one at night in the beginning?”

“Oh, yeah, first pill, and the higher the dose, the worse it got.”

I sighed. “Okay, I wish I had known that this happened, so you wouldn’t have suffered for three weeks. Here are a couple of other options…”

Both men left with new prescriptions and repeated instructions to notify me of any problems with their medications.

Just like the man with alarming new symptoms, who delayed getting evaluated and said “I thought I’d wait until my appointment”, so many people seem locked into the thinking that their doctor only exists in the physical sphere of the office visit. When I wrote about it two weeks ago, I described it as a systems problem. I blamed our clinics for making it hard for patients to stay in touch with us.

Samuel is from the older generation that may not feel comfortable “bothering” his doctor, but Tristan is young with friends in healthcare and service industries. He calls me by my first name and isn’t viewing me as unapproachable as far as I can tell.

I still haven’t mastered the Art of explaining new medications, obviously.

The Art of Prescribing (Or Not)

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.


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