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Monday, June 29, 2009

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The 'naughty' patient By STAFF WRITER ~ Nassau Guardian: If there's one thing Samuel Jones' doctor has drilled into him, it's that he must take his seizure medication daily at the same time, to ensure that the meds remain at a consistent level in his system to control any epileptic onsets. But this isn't something the 40-year old adheres to. He admits to not taking his medication for sometimes 24 hours at a time, and then doubling up to ensure that his ailment stays controlled. Jones is one of those persons, Dr. James Constantakis would refer to as a "naughty" patient — a person who does not do what his doctors have told him to do. "It's no good going to a doctor . . . he prescribes you medication, and you're not doing the right things," said the general practitioner, who said on his weekly Health Matters show on Star 106.5 FM that 60 to 75 percent of his patients he estimates make the same mistake over and over again. "Patients resist taking their drugs for the wrong reason. For example, the one question they'll ask is 'Do you mean I'm going to have to take this medication forever?' Patients don't like to hear the word forever, which seems like a very long time," says Dr. Constantakis. Jones is one of those people. When the doctors said he would have to take Dilantin for the rest of his life, he balked initially, but started taking it more often when he realized he wasn't as compliant as he should have been. "I just didn't want to have to take pills everyday. It was annoying, and I didn't want people to know" he said. According to Dr. Constantakis, this is where communication is key between medical professional and patient. "It makes no sense for a patient to be prescribed the best drug from the smartest doctor — and the reason for doing so isn't communicated to the patient. The person doesn't take the drug, and prescribing the drug then becomes useless, because the patient doesn't get better. When a doctor says you have to take this forever, or you can't stop taking it — it doesn't mean that you don't want to get hooked on a pill. That's a misconception," he said. Dr. Constantakis says "naughty" patients are those people who ask the doctor to re-check their blood pressure if the test returns high. Their excuse being they were nervous. "If you get nervous in the doctor's office, you will get nervous anywhere — in traffic, when you go home when your wife starts screaming at you, so listen to the doctor, and take your pill as prescribed," the doctor urged. Jones is also one of those patients who will take his epilepsy medication later in the day, because he doesn't want to take it while popping a multi-vitamin or an over-the-counter headache medication for fear of what will happen. According to Dr. Constantakis if the doctor says take all pills in the morning, take all in the morning. "It's like saying I will have my chicken in the morning, my mashed potatoes in the afternoon and my corn in the evening. You can have it all together, because most pills can be taken all together if the doctor says so," he said. He did add that when a doctor asks what medications you're taking that you should always 'fess up and tell the truth, because there are some medications that aren't compatible. "Sometimes there are specific instructions that you must follow, so you have to be a patient who does what the doctor says. Communication, is a very important part of medicine, and you must be a good patient and listen to your doctor. "Patients who are taking blood thinners, must take it exactly as prescribed. It might be three one day — two one day, three the next, skip a day . . . it gets very complicated sometimes. Some patients forget, and they might take their [medication] in the morning, forget they took it and double down on the dose. They may get away with it once, but that's very dangerous. It's when patients forget that they run into problems," he said. Some of the "naughtiest" patients he said are those who don't take enough of their medication, even if it was communicated to them that they should. "If someone is prescribed antibiotics for a cold or flu, or sore throat, and start to feel better after three days, they then don't think it's necessary to take the complete 10-day dosage," he said adding that this is wrong. "When you take the antibiotic, it takes at least five days to a week usually to kill all of the bacteria. Some are going to be tougher than others, and on the third days most are gone, but there are still some toughies out there. And on the fourth day, there is less bacteria, but the resistant ones are still hanging on by the skin of their teeth, so you stop taking your antibiotics on the fifth day because you didn't listen to your doctor, and those little toughies that were able to handle the antibiotics a bit, start to reproduce their own kind that are tougher to those antibiotics and that's how you build resistance." He says if you start taking the medication again it makes it worse, because you then have an anti-body that the bugs are used to. Then there are those people that take antibiotics, that don't need them, because they have a virus. He says these "naughty" people pressure their doctors in giving them the prescription. "They say I'm coming down with a cold, I'm going away, and I want to nip it in the bud, give me some antibiotics. And you try to explain to them that it doesn't work, it's a virus, and you will lose that patient. They will go somewhere else where they will get it. So I blame the doctor for being pressured sometimes, [and] I blame the patient for being very good at pressuring the doctor, and hence the 'naughty' patient." Dr. Constantakis also says not to be a "naughty" patient and to do your follow-up visits as prescribed by doctors, and to not always think a doctor is looking for a way to "squeeze" more money out of you. "The doctor wants to make sure the diagnosis is correct, and that there's not something else going on. We want to re-check the blood pressure, and that it's going down and that the headache isn't just more than tension headache, so follow-up visits are very important and the doctor isn't just doing it for money." Monday, June 29, 2009