Ignoring Valid Doctor Advice - why does it happen so Often?
Have you ever been to a doctor, taken the prescription home, but never filled it because you had objections to the medicines? Sometimes the medicines are too expensive; sometimes what you read on the Internet leaves you feeling unsure of what they would do to you. A physician I've been going to for years told me about how he used to have a patient whom he treated for a terrible problem with spontaneous bleeding. One day, when he didn't turn up for his appointment, the doctor called him up at home and found that he had died from spontaneous bleeding. The physician felt like a failure. If he was treating him, and if he died of the very same disease, didn't mean that the physician did not do a good job? It seemed to make sense this way and not at the same time; so he visited the family of the patient to dig deeper. A few questions on, he discovered what happened to the patient; he had read up all kinds of scary stories on the Internet about some of the incidental effects of the medicine he was prescribed, and just ignored the doctor advice, prescription and all. It's quite another matter that reading up about drugs on the Internet isn't exactly a useful thing to do - they could scare you off aspirin that way, with its possible brain hemorrhaging effects.
Now, the doctor could have felt that this discovery let him off the hook. If the patient ignored valid doctor advice how could the doctor possibly be responsible? But he didn't feel that way. Instead, he felt all the more responsible. He knew that there were lots of patients who refuse to take medicines for various personal reasons; and that he never heard of them. But the culture doesn't permit taking it up with the doctor about this, and it doesn't permit having the patient's own up to it. Patients are normally deathly afraid of the doctor and of ticking him off; and doctors generally don't have the time to ask these kinds of questions. When patients forget to take a dose or three, or when after two days of a course of antibiotics they don't see the point in continuing it for all five days, they would rather just lie to the doctor to avoid callng up an uncomfortable situation. Doctors don't want to deal with it, patients don't want to talk about it; how is anyone supposed to correct the situation?
How serious a problem is this anyway? Is there a number you could put on it? There have been studies done on this. One study finds that half of all patients avoid taking their medications seriously. The study also found that people who neglect to take their medications seriously when it comes to difficult diseases like blood pressure and diabetes, tend to die sooner, with more complications. There is a cost they attach to all the complications that arise out of people's refusal to take doctor advice seriously. They say it costs nearly $200 billion in lost productivity and lost lives in this country. It doesn't matter how scientific, how advanced medicine gets; if patients refuse to take the best scientific advice available, what use is all the advancement?
A Harvard medical school study tries to go deeper. They find that one out of five first-time prescriptions are never filled. When they compared the records they had of prescriptions, to the amount of insurance claims placed, they found that there was a certain pattern to the way people like to ignore legitimate doctor advice. In diseases that are likely to last all one's life like blood pressure or diabetes, a patient is more likely to not fill the first-time prescription. It could be denial. With patients who are young and who have simple infections, it appears they are in denial that they are vulnerable; their antibiotics prescriptions never get filled.
Is there a better explanation to why prescriptions never get filled? Cost is of course an important reason. And the way they make it pretty difficult to get your prescription filled at a pharmacy discourages people too. Just imagine - you need to take the prescription to the pharmacy, return to pick it up later, and then pay for it. In Europe where the medicines are paid for far easily by your insurance, and where getting your medicines doesn't involve the hassle, patients go get their medicines far more often. We just need to work on making the whole process easier to handle. It shouldn't be an option to ignore doctor advice; the health of the nation depends on it.
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