Tag Archives: Decision making

Medication Adherence Shouldn’t Be A Blame Game

by Karan Chhabra

We don’t have miracle drugs. But to many, statins come awful close. They lower cholesterol levels, slash mortality rates in people with heart disease, and we’re learning more about how they can even prevent cancer in healthy people. They’re cheap, too, and some of the most-prescribed pills out there. Like any other drug, they come with side effects, of which doctors and patients taking statins are well aware: muscle pain tops the list, but there’s also a risk of liver damage and potentially even developing diabetes. But research published last week shows that the problem is bigger than we think: we thought only 5-10% of patients came down with side effects [1], but this study says it’s actually more like 17%—almost double. About 60% of those patients suffering side effects stopped taking statins, at least temporarily, as a result.

This is important information for clinicians, patients, and policymakers. A lively discussion is still underway on whether we should be giving statins to healthy patients who don’t currently have heart disease, and these new data should enter that discussion. Patients, too, deserve an accurate picture of what they’re getting themselves into.

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Helping Your Doctor Help You (Part II of II)

by Karan Chhabra

Ubel critical_decisions_cover

This is the second in a two-part interview with Dr. Peter Ubel, a physician, behavioral scientist, and author of the book Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices TogetherMissed Part I? It’s right here

KARAN: You referred to patient education earlier, not just in terms of treatment information but also the types of questions to be asking. But what about the former? Our generation is definitely comfortable using technology to look up health information, and we get a ton of information through news, magazines, and the general media. But not all of it’s good. So how do you recommend people sift through the good and bad information out there, when they’re trying to inform themselves before a visit to the doctor.

DR. UBEL: Of course, the education system should help people learn how to objectively look at things and help them when things go over their heads.

But the other thing I’d say is, print out and bring in the stuff that you see online, show it to your doctor, and let them tell you what’s right or wrong about it. Then they’ll know what you care about more than they did before, which is really valuable. Your doctor shouldn’t be threatened when you bring these materials in; they should be happy that you’re helping focus the visit on the topics you care about. If you’ve got misconceptions that are affecting the way you’re behaving, like what pills you’re taking or not taking, the doctor should be happy to have a chance to address those misconceptions.

So: print it out; bring it in.

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Helping Your Doctor Help You (Part I of II)

by Karan Chhabra

Ubel critical_decisions_cover

Dr. Peter Ubel is a physician and behavioral scientist at Duke, as well as an author and personal mentor/hero. I recently read his latest book, Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together, and recommend it highly to anyone interested in making the right medical decisions—either as a patient or a practitioner. I spent a lot of time with the topic when I wrote my Honors thesis, but Dr. Ubel‘s book beats everything else I’ve read at dissecting the psychological and historical quirks that make decision-making such a complicated issue. In addition, it offers a lot of concrete advice on how to do the decision-making dance better.

Dr. Ubel and I had this interview to elaborate on how his book applies to the Millennial generation and our unique medical needs. Because the conversation was so chock-full of decision-making goodness, we had to split it up into two parts—the second half can be found here.

KARAN: Though I hope our readers all read your book, for those who haven’t just yet, I want to start with an example that touches on the issues it discusses. I recently got a bad ankle sprain. The following week, I went to a local orthopedic surgeon for it. He was a very old-school doctor; before even talking about treatment options at all, he was getting his stuff out to give me a cortisone shot for my ankle. I was still trying to give him my history and symptoms and I had to stop to ask what he was doing. It was a little scary; I had no desire to get a shot, and from whatever little I know, I think cortisone might’ve even hurt more than it helped. But I’m obviously not residency-trained in orthopedic surgery, so I didn’t feel right questioning his opinion. So while I have seen how the patient autonomy movement has affected the way doctors are ethically trained, which you discuss in your book, I still think there are a lot of doctors who fit the old mold. As a patient, especially a young and inexperienced patient, it’s difficult sometimes to know how to respond.

DR. UBEL: I don’t think this is an old/young issue. If anything, people tend to think their older patients are more deferential than the younger ones. Most people in their 20s are more into the “consumer” mindset than older people who grew up in the “doctor knows best” era. But when you are young, the age difference between you and the doctor is bigger, so that could make it harder to be assertive when interacting with your doctor. But patients ought to feel they can assert themselves because, even for mundane issues, any time there’s more than one way to go about it, the patient deserves to know what their alternatives are and to be a partner in the decision. So what happened to you is not the best possible medical care. Whether the doctor made the right choice, that’s one thing. But if he didn’t say “One thing we could do is this, but you should know, there are other alternative. For example, if you don’t want to get a shot, we could just give it time, etc.” If the physician didn’t speak to you that way, that’s a problem.

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