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Why Do Patients Stop Taking Their Medications?

Lots of smart people over the years have been trying to figure out why people stop taking their medications within the first 12 months.  Within the first 12-months of starting a new prescription, patient compliance rates drop to less than 50%.  This rate is even lower for people with multiple chronic conditions taking one or more prescription medications.

If these medications are so important to patients, why do they just stop taking them? It defies common sense. Sure issues like medication cost, forgetfulness, lack of symptoms, and psychosocial issues like depression play a role in patient non-compliance. But there also something else going on…or in this case not going on.

The problem is that doctors and patients simply don’t talk much about new medications once prescribed. Here’s what I mean.  Let’s say that at a routine check-up a physician tells a patient that he/she wants to put them on a medication to help them control their cholesterol.  The doctor spends about 50 seconds telling the patient about the medication.  The patient nods their head takes the prescription and boom…the visit is over. Read more »

*This blog post was originally published at Mind The Gap*

New Mothers Who Don’t Follow Breastfeeding Guidelines Cost Us Billions

Poor compliance with breastfeeding recommendations costs the nation at least $13 billion each year, with nearly all of the cost related to infant morbidity and mortality, according to a comprehensive economic analysis.

If 90% of new mothers followed guidelines for six months of exclusive breastfeeding for their children, an estimated 911 deaths would be prevented annually, said authors Melissa Bartick, MD, MSc, of Harvard Medical School, and Arnold Reinhold, MBA, of the Alliance for the Prudent Use of Antibiotics, both in Boston. Read more »

*This blog post was originally published at*

Fear Of Death Can Motivate Patients To Take Their Medicines

As a hospitalist I sometimes come across patients who, for what ever reason, refuse to take the medications prescribed by their in-patient doctors.  Some patients refuse out of fear.  Some doctor told them years ago that taking medication X would make them worse.  Some patients refuse out of ignorance of their disease process.  Most of the time however, they just don’t understand why the medication is necessary.  Some patients just refuse out of stubbornness.  And some patients refuse because they have a really good reason.

However, when you’re dealing with critical illness and the only thing that’s going to save your patient’s life is a treatment plan they are refusing, sometimes you have to be in their face with reality.  So how do I handle situations with patients who have the capacity to make poor medical decisions but refuse life saving medications?  How do I convince my hospitalized patients to take their medications I’ve prescribed? Read more »

*This blog post was originally published at Happy Hospitalist*

Oh, The Games People Play


I never knew this game existed until I did a web search for the character! There are actually pristine, unopened Cherry Ames games on eBay.

No, I didn’t buy one. Seventy-five dollars is a wee bit too much to pay, although I did spend that much on a vintage Barbie outfit about ten years ago.

Hey, it came with the original shoes and Barbie fans know it’s all about the shoes!

(UPDATE 5/09: My co-worker gave me all of her Cherry Ames books – a complete set – and a copy of the game, in perfect condition!)


Those who study human behavior should spend a shift in the emergency department.

The games played in the ER make the Olympics look like a tetherball tournament. Some of the participants are patients and some are staff. Some are gold-medalists in their specialty and some arrive a few feet short of a full balance beam.

Let’s take a look at “The Emergency Olympic Games”:

“The Suck-Up”

Usually the player is suffering from an acute lack of an opiate prescription for chronic pain symptoms with a nebulous origin for which they have not been evaluated by a doctor but they have an appointment with a specialist next week but they ran out of their Vicodin and they just cannot bear it.

Said patient is overwhelmingly complimentary to Team Nursing . The targeted nurse is SO much nicer than any other nurse anywhere in the whole world and gee, that other nurse was so rude they wish ALL nurses were just like you! These compliments are dispensed within 3.5 seconds of spotting the nurse, often making said RN feel an acute need for a shower.

The player realizes she is out of medal contention when the targeted nurse responds with, “Gee, thanks, but I just came in to get a Betadine swab….”

”Mean Medical Matchup”

This game is closely related to the Suck-Up, utilizing the same team.

Player has been evaluated by the ER doctor, who, having the audacity to disbelieve their story, has gone for the gold and verbalized his lack of belief to the patient. Bottom line: no prescription. The patient prepares for this event with the “Which Doctor is On Tonight?” drill, using a telephone to assess the playing field before engaging the opponent.

“Peek-a-Boo Bypass”

This event requires a large team that converges on the patient’s playing field soon after the patient’s arrival. Anyone can make the Peek-a-Boo team, although it is usually composed of family members and friends of many generations.

Upon arrival, Team Nursing announces the event rule: only two members of the Peek-a-Boo team on the field at a time. This is met with a courteous response and extraneous members go to the bench in the waiting room, where the goal is getting back onto the playing field without Team Nursing noticing. This is accomplished by one Peek-a-Boo team member returning to the patient at a time until the bedside number has quadrupled. Stealth and dexterity are assets to this goal. Occasionally Team Security will act as referee.

“The Two Guy Offense”

The preliminaries for this event take place off the Emergency Stadium grounds.

The player reports a spontaneous assault by Team Two Guys. The members of this team are always unknown to the patient and the initiation of contact always unprovoked.

The goal of Team Patient is to obtain care from Team Medical with minimal disclosure of the playbook. The involvement of Team Police is always declined as so as not to incur a penalty. Team Two Guys apparently has many expansion franchises.

“The Two Beer Defense”

Team Patient enters the arena via Team Paramedic, having received a report of “player down” on the sidelines of a local Team Seven-Eleven. Team Patient arrives supine on a movable gamepiece.

Upon arrival in ER Stadium, body fluids are released for assessment by Team Nursing who immediately take defensive positions. Performance-enhancing ETOH is suspected as the characterisic Odor Offense is noted. Team Medical waits for the Designated Cleaners and takes the field.

Minimal interaction takes place between the teams for many hours at which point Team Patient verbalizes that he only had “two beers”. Team Medical knows to multiply this number by 58. Team Patient is taken out of the medals race on a credibility technicality.

“The Decibel Debate”

Team Patient attempts to propel themselves off the bench and onto the playing field by increasing their verbal intensity. Team Nursing counters with internal auditory blocking mechanisms. The goal: Team Patient enters playing field at appropriate interval. Team Patient rarely medals in this event.

“The Titanic Panic”

Team Patient arrives, usually via Team Paramedic, complaining of numbness, chest pain, shortness of breath and near-syncope occurring at the preliminary event at Home Arena which involved a “Decibel Debate” with another member of Team Family.

The Peek-a-Boo team arrives to act as cheerleaders for the event. No medal is awarded, as the full cardiac work-up that ensues turns out to be negative. An Academy Award nomination, however, would be appropriate.

These are just some of the Emergency Olympic events to which I have a front row seat and perpetual season tickets!

*This blog post was originally published at Emergiblog*

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