Wednesday, December 17, 2014
Wisdom Wednesday: The Doctor-Patient Partnership
I recently reviewed the Targets and Self-Management for the Control of Blood Pressure in Stroke and at Risk Groups (TASMIN-SR). This study was published by Professor Richard McManus and colleagues in 2013.
The study documented the value of patients adjusting their own medication through self-monitoring of blood pressure in addition to the standard medical supervision.
This was a follow-up study to two previous studies that documented the value of monitoring blood pressure at home and then providing that data to the primary care physician. Both of those studies failed to change the standards of medical practice for the treatment of hypertension. In fact, the “gold standard” for screening, diagnosis and management of hypertension remains conventional office BP (blood pressure) measurement.
The question now being asked of the medical community: Are patients and providers ready to partner? Unfortunately, in most medical practices, the answer remains no.
Physicians often talk about poor patient compliance and I must admit, I have been one of those physicians. However, compliance is not the issue. Patients are not bound to comply with “doctor’s orders”.
Too often I see patients that blindly follow the doctor’s recommendations without question. This is how patients end up on 16 prescription drugs, many of which have detrimental interactions and are contraindicated. It is estimated that fully one-third of the diagnosed cases of dementia in this country are just over medicated patients who would recover their faculties if some or all of their medication was discontinued.
The doctor-patient relationship must be a partnership to work optimally. The patient hires the doctor to evaluate, diagnosis, and recommend a course of treatment. That course of treatment always requires some action by the patient – altered diet, physical activity, taking of medications, etc.
The physician’s job is to make the best possible recommendations to improve the patient’s health and well-being.
The patient is entitled to accept or reject any or all aspects of those recommendations. I also believe that the patient has an obligation to share those conclusions with the physician – that is vital to the relationship.
Hopefully, the doctor and patient find a comfortable compromise. Patients should never accept treatment that they do not agree with and physicians should never agree to treatment (or lack of treatment) that jeopardizes the health of the patient.
For example, I may recommend fish oil to a patient to reduce inflammation when treating their acute low back pain. They might object to taking the fish oil because they are vegetarian. The compromise might be flax seed oil that provides the omega 3 fatty acids necessary to reduce prostaglandin inflammation. However, if I find that they can’t convert the omega 3 fatty acids into EPA and DHA, then I cannot, in good conscience, agree to that compromise.
THE BOTTOM LINE:
Please try to partner with your physician(s). Let them know when you have concerns about any aspect of treatment (or lack thereof). When you agree to a specific therapy, please do your best to follow through. A lack of partnership will sabotage almost any viable therapy.