Tuesday, February 16, 2016

How Good Medicine Has Become The Exception

Joe had one of the best geriatricians in the city.  So when he got a call from the pharmacist saying his new prescription was ready, he assumed that it had to do with his recent annual visit and blood draw. His suspicions were confirmed, a few minutes later, when he got through to the nurse at the office.

Joe was politely informed that he had high cholesterol and was being put on a statin. Although he hung up the phone satisfied and raced out to the pharmacy to pick up his new pills, a casual observer might find a few things concerning.

Neither the doctor nor the nurse actually talked to Joe about the significance of high cholesterol. No one bothered to discuss with him the risks and benefits of statin medications.  There was no mention of side effects or complications.  No joint decision making.  And certainly no consideration of a trial of diet and exercise.

A few weeks later, Joe received his results in the mail.  He marveled at the total cholesterol reading of 227.  But no one explained that a large part of his total cholesterol was made up of HDL or good cholesterol.  Joe's HDL of 75 was actually protective when it comes to cardiac disease.  His bad, or LDL cholesterol, was 148.  Not perfect, but not horrible either.

Now, did I happen to mention that Joe is 85 years old and is only on one other medication?  He takes a piddling dose of Lisinopril for high blood pressure.  Joe has never had a heart attack.  Never had a stroke.  He doesn't smoke or have diabetes. He exercises daily and has a normal BMI and waist circumference.

Joe has an exceedingly low risk of having a cardiac event, and in his case, a statin has a much greater likelihood of causing harm than good.  

Yet now he takes Simvastatin, and avoids eating his favorite desserts.

This is not just a fictional story, it happened.

You would think that by now we would be better than this.

But a large number of physicians are still practicing medicine without using even a modicum of evidence or common sense.

And actively engaging patients in shared decision making is still the exception and not the rule.


TrishaGal said...

And then he starts eating grapefruit because it's healthy and nobody told him not to. And then he starts having muscle aches. And then he is in too much pain to walk for exercise. And then he has a bunch of bloodwork to figure out why his muscles hurt. And then maybe the statin is changed or stopped.

Anonymous said...

…because billing codes and "quality" measures are similarly developed without even a modicum of common sense.

norxgirl said...

Thank u for this piece. Side effects Lipitor FB page with many members who have been damaged by unnecessary statins, one of whom used to work ICU, but now stay-at-home dad due to disabled from statins. Is it any wonder there is so much Medical PTSD out there....is there some way to test for critical thinking skills, which may even actually be less than supportive of authoritarian medical culture, when deciding which candidates to choose for much coveted medical school, residency, fellowship spots....

Unknown said...

Superlative essay, all the more meaningful because it is penned by a physician. I have reposted it to all my followers on Facebook and Linked in. With any luck, it will give them food for thought and encourage them to intervene and advocate for their loved ones. I am a dementia consultant to families with a family member who has a form of dementia ( read private case manager). Thanks for the article. You've done some REAL good here, today.
Carole Larkin- www.thirdageservices.com.

Unknown said...

Or even more likely they add another pill.