Tuesday, January 23, 2018
Health

Know your mind, protect your health, authors say

Do you follow doctor's orders?

I suspect few of us are flawless in this department. Maybe you forgot your routine screening mammogram. Or you're still carrying the extra 10 pounds that are aggravating that bum knee.

Perhaps the prescription the doctor wrote is still sitting in your wallet, long after you were supposed to start taking one pill every day.

What the experts call "patient noncompliance'' can be a very big deal. A report last year in the Annals of Internal Medicine declared that up to 30 percent of prescriptions are never filled, and perhaps half of all medications aren't taken as prescribed. Ten percent of all hospitalizations might be avoided if everyone did as they were told.

The researchers suggested measures to make medications more affordable and to help patients understand why taking them is important, and all that makes sense.

But often, another prescription might be in order: Knowing your own medical mind. It could help you to make health care choices you'll actually carry out.

I'm borrowing the phrase from the book Your Medical Mind: How To Decide What Is Right For You, by two Harvard physicians, Jerome Groopman and Pamela Hartzband. It's a lively, thought-provoking read for anyone who is facing difficult choices, or who'd just like to communicate better with doctors. They write engagingly about patients and doctors with various issues and perspectives, and how it all worked out.

Some medical decisions are clear-cut, they write; others are only made to appear so by physicians with their own biases.

I saw Groopman and Hartzband lecture on this topic recently at the Association of Health Care Journalists conference in Boston. They're a married couple, though they approach medical choices rather differently.

He is the epitome of one type of patient they write about, the "maximalist believer'' — drawn to the latest and greatest medicine has to offer. She is a "minimalist doubter,'' preferring to stick with tried and true treatment, and not too much of it.

Knowing your own mind-set can help you navigate decisions for which there may be several reasonable approaches. That is, of course, if your doctor presents all the options.

"As physicians, we've both found ourselves at times too quickly telling our patients which treatments we prefer rather than working with them to understand their own thinking,'' Groopman and Hartzband write.

"Of course, patients may want, and often ask, what their physicians think is best. But that should occur after information is presented in a neutral way.''

Recently, a friend told me that his doctor's office called after his checkup to say his cholesterol was high, and he needed a statin drug.

The prescription arrived, and my minimalist friend — annoyed that the doctor never discussed it with him — ignored it. He picked up a pamphlet about dietary changes to address cholesterol, which he's doing on his own.

This, I suppose, makes him a noncompliant patient.

Groopman and Hartzband write about a woman who weighed the same decision as my friend. After reviewing the data on statins — which are a lot more controversial than you might think for one of the most prescribed drugs in the nation — she declined.

That's a reasonable call for her to have made, they write.

I hope my friend calls his doctor for a follow-up cholesterol check and a further discussion of his options. Perhaps I'll slip him a copy of Your Medical Mind to help him prepare.

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