Erickson Tribune

Health Secrets

UPDATED: Monday, May 22, 2006

Choosing Medications: Doctor vs. Patient Responsibility

Posted on Thursday, June 01, 2006
 

By Wendy J. Meyeroff
THE ERICKSON TRIBUNE

In 1997, the Food & Drug Administration (FDA) allowed direct-to-consumer (DTC) prescription drug advertising. The up side of DTC ads is they can create a dialogue between doctor and patient. For example, some physicians have reported that more men talk openly about erectile problems thanks to ads for drugs like Viagra.

More experts wonder, how often patient requests automatically lead to a prescription without true exams. A disturbing study published last year in the Journal of the American Medical Association found that may be happening more often than most people realize.

Dialogue or Appeasement?

The study used actors pretending to be patients with one of two problems: “true depression” (described to the doctor using realistic depressive symptoms, like extensive periods of sadness) versus “adjustment disorder,” a problem like getting used to retirement. Medication is often recommended for the first condition, but not the second. The doctors who agreed to participate in the study knew they would see fake patients, but didn’t know who they would be or when they would appear.

The actors not only pretended to have the different conditions, but in various scenarios they asked the doctor to prescribe a specific antidepressant, Paxil.

The result? Whether or not the patients actually “displayed” real symptoms of depression, in more than half the cases they got a prescription for an antidepressant— and over half the prescriptions received were specifically for Paxil. Even when the “patient” was pretending to have adjustment disorder and shouldn’t have received medication, 10 percent received a prescription and that increased to 55 percent when Paxil was specifically requested. That shouldn’t happen.

The Doctor’s Role


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Matt Narrett, M.D., chief medical officer for Erickson Communities, remembers when the Vioxx recall hit and patients came in demanding medication changes. “Some asked for other prescription drugs in the category, like Celebrex. Others thought they could just start taking over-thecounter (OTC) medicines, like Advil. It was the job of Erickson HealthSM physicians to carefully evaluate their patients entire medical history and help them determine their best option. Sometimes it wasn’t medication; it might have been a non-drug alternative like physical therapy.”

Erickson HealthSM Advantages

Each Erickson HealthSM physician has a patient load of no more than 400 patients yearly, versus at least 2,000 patients for outside doctors. That means an Erickson HealthSM physician gets to know people and has time to talk to them—an average of 25 minutes, instead of the industry average of 9.3 minutes. Erickson HealthSM physicians also use Centricity. This electronic medical records system gives them instant access to a patient’s complete medical history. That helps them make appropriate recommendations for each patient.

Now It’s Your Turn

If your doctor doesn’t have such time or resources, it’s up to you to take charge. Ask about a drug—bring in the ad if you like—but don’t demand it. Make sure your doctor takes time to talk about it. Find out why this may or may not be a better option for you.

Your primary care doctor may not know the medicine you are requesting if it’s new or for a specialized therapy. Either come back after he/she has had a chance to research it, or ask if a specialist might be better able to answer your questions.

Never assume you can switch to an OTC or “natural” medicine with impunity. Your doctor or pharmacist has the tools to research both prescription and non-prescription drugs and supplements; ask them to do so.

By all means, utilize your pharmacist. Kathy Justice, R.Ph., who manages the pharmacy at Charlestown, a community in Maryland built and managed by Erickson, welcomes questions from residents. “Our residents come in or call, with questions like whether they can take Tylenol with their blood pressure medicine. If we don’t know an answer, we’re always happy to check.”

Finally, don’t be angry when the doctor says, “No, this isn’t right for you.” Too many times consumers ignore their doctor’s answers and buy something anyway, especially if they have seen the  product work on someone else.

But remember: you are not that other person even if you are related. Unless you are identical twins, you don’t have the same genes. And you are probably not taking all the same medicines for the same health conditions. So you can’t really be sure what helped them, will help you. When it comes to any type of drug therapies (even natural supplements) it’s better to err on the side of caution.



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