“I’m just not a pill person” – and other annoying excuses

drugs hands

by Carolyn Thomas    @HeartSisters

Dr. Lisa Rosenbaum writes in the New England Journal of Medicine about a friend who is worried about her father since two of his sisters have recently died following strokes.  She asks her friend:

“Is he on aspirin?”

“Oh, heavens, no,” the friend replies. “My parents are totally against taking any medications.”

“But why?”

“They don’t believe in them.”

Curious about what she calls this instinctive non-belief, a commonly observed reluctance to take the medications their physicians recommend (aka non-compliance or the slightly less patronizing non-adherence), Dr. Rosenbaum wanted to understand how patients feel about taking cardiac medications. The consequences of not taking one’s meds can be deadly, yet almost half of all heart patients are famously reluctant to do so.(1)   Dr. Rosenbaum, a cardiologist at Boston’s Brigham and Women’s Hospital, wondered: Are there emotional barriers? Where do they come from? Can we find better ways of increasing medication adherence if we understand these barriers?*

So she interviewed patients who’d had a myocardial infarction (heart attack) – first at the time of the initial cardiac event, and again months later.  Their answers fell into five distinct themes that might be surprising to doctors feeling frustrated by their non-compliant patients. Continue reading ““I’m just not a pill person” – and other annoying excuses”

Confessions of a non-compliant patient

by Carolyn Thomas @HeartSisters


Consider this scenario, dear reader:  I’m lying in bed one Sunday evening, settled in to watch 60 Minutes for the next hour. But this Sunday is different from any other Sunday because I’ve had three new things to deal with during the past week that are utterly separate from my laundry list of daily cardiac concerns:

  1. I’ve been having physiotherapy three times a week because I twisted my right knee (same one I had knee surgery on seven years ago).
  2. I’m using a new prescription ointment for a pesky patch of psoriasis on my left elbow.
  3. I’m wearing a brand new acrylic mouth guard to bed every night that my dentist has just made for me to help treat a longstanding jaw alignment problem.

So. Here I am lying in bed that Sunday evening as our story unfolds . . . Continue reading “Confessions of a non-compliant patient”

Living with the “burden of treatment”

by Carolyn Thomas  @HeartSisters

Endocrinologist Dr. Victor Montori of Mayo Clinic describes two types of patients living with chronic illness who don’t follow their physicians’ advice when it comes to implementing recommended treatments or therapies. The first group may just not want to take the pills, or they want to try natural remedies instead, or they want to get better on their own, or they can’t afford their meds, or they just don’t trust that these recommendations will work for them.

But the second group of patients, Dr. Montori explains, may be working very hard to do everything their doctors have suggested (like taking prescribed meds, monitoring their vital signs, coming to all appointments – not only with doctors but with nurses or dieticians or other health care providers). Doing all that takes so much time and effort – on top of feeling sick a lot, juggling family, work and social life – that it can get to be too much.

So they just stop doing it.

Dr. Montori and his like-minded colleagues call this scenario the “burden of treatment” for patients.  Continue reading “Living with the “burden of treatment””