Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Wednesday, November 18, 2009

Whose Medicine is it Anyway?

Hypertension, or high blood pressure, is one of the most commonly diagnosed chronic conditions seen in this country. What many people don't realize, though, is that a single blood pressure reading is not enough to make a formal diagnosis of hypertension. Technically, you need three readings on separate occasions -- preferably different days -- to make the diagnosis. Because I like to use sports analogies, I tell my patients that the diagnosis of hypertension doesn't happen until you have "three strikes."

What I usually do when I first measure a blood pressure higher than 140/90 is to explain this to the patient. I also discuss the role of weight loss, exercise, and sodium restriction in reducing it. Then I ask them to come back in a month to re-check the blood pressure. With any luck -- and with aggressive lifestyle modifications on the patient's part -- a mildly elevated blood pressure can respond before I ever make the diagnosis, coincidentally sparing the patient the official record of a "pre-existing condition."

I saw a guy the other day with "strike two". His blood pressure was still about 150/100. He wasn't all that overweight and his diet was already pretty good, so I started trying to prepare him for the fact that he would likely require medication to control his blood pressure. Like many people, he wasn't keen on that idea. He scowled as he said, "Okay, we'll give it one more month. Then I guess I'll take your damn medicine."

I thought, "What do you mean, my medicine?" My blood pressure is fine (as are my cholesterol and thyroid, thanks to better living through chemistry). I'm talking about medicine for you, Mr. Patient. Which got me to thinking:

Whose medicine is it anyway?

As prescribing physicians, we often talk about all the medications at "our" disposal. Is studying, understanding, recommending and writing for drugs enough to invest us with their "ownership"? Or does filling the prescription, paying for and swallowing the pills carry more weight?

I guess that's the source of the expression, "to take one's medicine."


At Wed Nov 18, 07:46:00 PM, Anonymous Anonymous said...

Well, considering I paid 150 bucks for my one-a-half-month (don't ask) supply of Asacol, it sure as hell is MINE!!

Kensington MD

P.S. Yes, that's after insurance. Before insurance it was $750.

At Wed Nov 18, 08:34:00 PM, Anonymous Celeste said...

Your recommendation, your pills I guess!

Weird how put upon he acted, like he was rebelling against authority.

At Thu Nov 19, 06:31:00 AM, Anonymous Anonymous said...

Actually, apparently it really is widespread that folks don't take their meds as described. (I was just reviewing the "Why Patients Don't Take Their Meds" page at I observed a breathtaking example of this when the hematology resident checking out my daughter, who was in the hospital for a hemolytic crisis associated with her spherocytosis, asked, "Who else in your family has spherocytosis?"

"No one," I replied.

"Everyone in my family has it," she said.

"Really? Do you?"

"Oh, yes," she said, and she patiently submitted to all my questions. (I'd never met anyone other than my daughter who had spherocytosis before -- much less a doctor -- and I was going to milk this informational resource for all it was worth.)

She told me that she'd had a splenectomy when she was six (showed us the scar) and when I asked about the implications of that, she said, "Yeah, I do have to take a lot of antibiotics to prevent certain blood infections. I'm not real good at taking my meds, though."

A hematology resident without a spleen. Not good at taking her anti-blood infection meds.

I was speechless. (Yes, really, for once I was.)


Kensington MD

At Thu Nov 19, 06:35:00 AM, Anonymous Anonymous said...

Argh!! Why can't we edit comments?? Please consider the first sentence of my comment (the one immediately preceding this one) to read: "As you well know, it is common for folks not to take their meds as prescribed."

As you know.

And "prescribed."

My fingers work faster than by brain.


Kensington MD

P.S. And yes, I did preview & proof that comment, but some things still slip through.

At Thu Nov 19, 07:00:00 AM, Anonymous T4 said...

Prescribing medication to somebody who doesn't feel ill, that's probably the greatest obstacle in treating (primary) hypertension. It might be *his* medication, but it sure is *your* advice ;)

At Mon Dec 21, 07:45:00 PM, Anonymous Anonymous said...

I'd love to take "my" medicine. I wish my insurance had prescription coverage. It doesn't, and won't, and I'm 42. I'll start taking my medicine if and when I get to 65.


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