Tuesday, July 25, 2006

A Doc's Life - More Memorable Moments (P.S. 4)

Scenario: GP Clinic; patient previously diagnosed with hypertension.

Again, this doesn't refer to one isolated case, but is a description of a commonly encountered situation involving hypertensive patients. Oftentimes, the patient comes in, not with the intention for follow-up of high blood pressure, but for another complaint, eg URTI, GE etc.

Me (after handling the presenting complaint): "By the way, I notice that you are on Drug XYZ for high blood pressure. Let's check your blood pressure & see how well controlled it is."

Patient:"I stopped taking the medicine already."

Me:" Why?"

At this point, there are two possible answers which illustrate misconceptions that patients have regarding the condition of hypertension:

a) Patient:"I finished the whole course already, so I thought I am cured."
b) Patient:"My friends told me that I shouldn't keep taking the medicine otherwise I will never be able to stop." (For some reason, some patients think that anti-hypertensives have some kind of addictive effect on their bodies).

I have lost count of the number of times where I have had to explain the chronicity of hypertension & the need for close follow-up & medication to keep BP under control. Yes, I have even resorted to expounding scary complications of uncontrolled hypertension like stroke, heart problems, kidney failure etc. to get the point across.

I don't know if this ignorance is a local phenomenon, or whether my overseas colleagues also encounter the same misconceptions.

1 comment:

igakunogakusei said...

I speak from the context of the Cambridge (UK) locale, which has a populace of extremes - you have patients ranging from professors to foreign immigrants who speak little english.

Reasons a) & b) for non-compliance would be rare among the general population. They are fully aware of its chronicity, and generally know hypertension isn't like a subacute bacterial infection, and that treatment doesn't require "full courses" to minimise resistance.

What seems to be the biggest stumbling block to compliance is mainly the fact that patients don't develop symptoms, even after having voluntarily stopped taking their medication for a period. (Many patients admit this to medical students, not so much to their docs!) They don't like being "dependent" on medication, and the notion of having to take several pills for the rest of their lives isn't a glamorous picture.

Some patients also take wrong doses, especially after having had their regime modified, as is wont to happen, unless you are Prof Morris Brown of the Department of Clinical Pharmacology in Addenbrookes.