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The Doctor Is In: Nostrums and Notions

By Dr. Jim Ferguson

Have you ever gone to the refrigerator and found something unidentifiable in a Tupperware container?  There’s a great line by Walter Matthau in the Odd Couple movie.  His character Oscar is hosting a poker party and announces to his buddies, “I’ve got green sandwiches and brown ones.”  As I recall there wasn’t a high demand for these unidentifiable edibles.  None of us would put something in our mouths if we didn’t know what it was – except perhaps Ratatouille’s brother, and he’s a cartoon rat!

Honestly, it amazes me how many patients have no clue what medications they’re taking.  Some entrust their therapy to their spouse, and sometimes this is understandable if they’re confused, can’t read or too infirm to administer a complicated therapy program.  And I understand that medications are often confusing to patients; but folks you must take some responsibility for what you put in your mouth.

Last week I was trained to use a new computer based medication reconciliation program at our hospital.  All the doctors who still take care of hospitalized patients are taking this training which involves patients/families and nurses and pharmacists and doctors.  It often takes a team effort to figure out what patients are taking when they enter the hospital.  Sick patients and distraught families often have trouble giving an accurate list of medications or how they are being taken.

In general, I think Americans take too many pills.  Part of the problem is that we think the answer to our problems lies in a pill.  As an example, people frequently ask me about diet pills.  I’ve been in medicine forty years and the hope of an effective and safe diet pill remains elusive.  Sometimes I tell my patients that I was once fat and teased mercilessly as a kid.  I made up my mind in middle school that my will is stronger than my stomach’s growls.  I vowed never to be fat again and I still diet to this day.

Another problem is that like Congress, who continues to make laws and never cancels the obsolete ones, we doctors just add to a patient’s cocktail as new problems arise.  My all time record was another doctor’s patient who I admitted to the hospital one night.  Thirty-six different medications were listed!  I didn’t think it possible for that little lady to actually take all those pills, though I wondered what all that medicine would do to a person, if consumed.

When I see a patient in the office my nurse and I go over the medication list separately.  It is amazing that after two surveys with the patient I’ve found the list still inaccurate 25% of the time.  People don’t consider vitamins and herbs and supplements or non-prescription medications like Tylenol, Aleve or Motrin as therapeutic agents which can influence their therapy or interact with medications like warfarin, Plavix or blood pressure medication.  The French have a saying that you are what you eat.  I believe it works with medications as well.

I’m always looking for medications to eliminate or combine in a simpler way.  I once had an elderly lady who was always after me to reduce her pill list.  When I could do no more she said, “Humph; you’re a city boy aren’t you?”

I thought, oh no, here we go, and replied, “Well, yes, Mam, I am.”  And that’s when the education began.

She said, “Have you ever watched a chicken eat?”  Puzzled, but curious where this was going, I told her I had done so.  She then said, “Well, at breakfast every morning, I pore out your pills onto the table, and with a glass of water in my hand I pluck up those pills like corn in the barnyard.”  I carry that image in my mind thirty years later.

Many have observed that teenagers consider themselves as immortal, bullet proof and perhaps invisible.  Of course this is tongue in cheek, but it reflects an attitude that nothing will happen to them.  As we get older we realize there are consequences for our choices, but apparently the child in us remains because we believe that the system or the government will take care of us and we needn’t worry.  Folks, that is magical thinking and dangerous.  As hard as I try it isn’t enough; you must help me know what pills you put in your mouth.  The Cheshire Cat once said that if you don’t know where you’re going, any direction will do.  That doesn’t work with medication.

Maybe, Americans in the 21st century want to be taken care of and have chosen a perceived collective safety in place of individual responsibility and freedom.  I can tell you that the medical system, no matter how sophisticated, cannot replace your personal responsibility or your family’s participation in your care.  And I can tell you this with the certainty of forty years of experience, that things are even more complicated now and care is increasingly problematic in the New Order.

Be responsible and help me to help you!

 

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