Monday, August 18, 2014
What Happens When Patients Won't Take Meds?
You're here reading Shrink Rap, so you may think this is a post about patients who refuse to take psychiatric medications, and non-compliance with psychiatric medications gets to be it's own issue. So it caught my attention when Dr. Albert Fuchs tweeted that he was interviewed by NPR about "What happens when patients won't take medicines." Dr. Fuchs is a primary care doc with a concierge practice in Beverly Hills, so I wanted to hear what he had to say, and I invested 6 minutes of my life in listening to his NPR talk -- you may want to go to the website and listen as well. He makes a good point about being cautious when an addictive medication is prescribe, and he notes that in Los Angeles people are pro-health, anti-medication and perhaps that skews who he sees, but that medication refusal is common. I'm thinking that by the time you're paying an outrageous concierge fee to your primary care doc that either you're ill and feel you need extra attention or money's not an issue in your life -- after all it's Beverly Hills. But my other thought is why would someone invest in this type of care if they are not going to follow the doctor's suggestions? If you're going to blow your doc off, do it when there's a $20 co-pay.
That said, I'm not exactly the best of patients, and I've had a doctor who has wanted me to take calcium supplements for years. She is insistent. One look at me and one thing is clear: I'm well nourished. I don't think I need supplements, I think I get plenty of everything in my diet, and a close friend started taking calcium on the advise of her doctor and promptly got a kidney stone, and the literature suggests that dietary calcium is better than supplements, at least for people in some demographics . I assure my doctor that I ingest enough calcium. She's asked me what I eat, to which I've replied milk, yogurt, cheese, and ice cream. "Do you eat ice cream everyday?" Isn't that harassment? Of course I don't eat ice cream every day, but I wish I did. I surrendered, I bought a bottle of Tums and a few times a year, I eat one. This way, when I see this doc, I can say with impunity that I sometimes take Tums and this seems to stop the conversation. Maybe I'm wrong and someday I'll have brittle bones and wish I had listened and taken calcium supplements. So I have mixed feelings about whether one always needs to follow doctors' orders exactly and under what circumstances. Certainly the issue in psychiatry gets very complex if the patient is psychotic and repeatedly decides not to take medications and keeps ending up in the hospital or puts himself or others at risk.
In the meantime, my favorite flavor, for anyone who wishes to buy me ice cream, is praline pecan.
Posted by Dinah on Monday, August 18, 2014