Patients commonly come to me with their “bag of pills” wondering what they are all about.
The fact is that medications as a form of treatment can be confusing for many people. This is particularly true when patients are on many medicines, are elderly or suffer from chronic disease. Recent medication changes also lead to some confusion.
I begin with the assumption that all pills are chemicals. All medicines have some undesired side effects. There are no “magic bullets.” As many other things in the medical profession, the decision to choose a medication treatment is based on weighing the risks and the benefits.
I offer medication to a patient when there is evidence that the benefit of the medicine is greater than the risk of the medicine. Generally, it also must be true that the problem or disease being treated is problematic or potentially harmful in some way and the medicine is being used to prevent that harm.
There are many examples of how very toxic medications are used for patients with serious problems. One example is chemotherapy. Medication used to treat cancer is often very poisonous and, therefore, associated with all sorts of ill effects. Nevertheless, these medications are chosen because they are also poisonous to the cancer. The goal of treatment is to weaken or to kill the cancer rather than to harm the patient.
The physician-patient relationship is a sacred trust and, in my view, an equal relationship. As with all discussions about the care of patients, I believe that a doctor and patient must choose together whether a medication is appropriate.
The job of the doctor is to inform the patient of the potential benefits and risks of a proposed medicine and how it might help the patient’s problem or disease. The job of the patient is to let the doctor know what is reasonable for them.
Is the patient willing to take the medicine as prescribed? Is the patient aware of the benefits and potential risks and willing to discuss any concerns with the doctor when they arise? Does the patient understand what the medicine is being used for and how long the anticipated treatment will be?
One thing that is confusing for many patients about their medications is why a medicine is prescribed when they don’t feel bad. Some medications treat problems that take many years to produce symptoms. Nevertheless, the medicine may be able to prevent those future symptoms.
A good example is high cholesterol or high blood pressure. When present, these disorders often are not initially felt by the patient. If left untreated for years, however, conditions such as high blood pressure or high cholesterol can cause build-up of plaques in the body’s blood vessels and can lead to early heart attack and stroke. Medications are available to delay or prevent these problems.
I encourage all patients who have questions about their medications to talk to their doctor or pharmacist to find the answers. Patients deserve to know.
Dr. Matthew A. Clark is a board-certified physician in internal medicine and pediatrics practicing at the Ute Mountain Ute Health Center in Towaoc.
