I hate pills!
Channel: York Cardiology
Date: 2021-03-13

One of the biggest banes of the lives of patients is the number of tablets they have to take and that number always only seems to go up. Rarely do we come back from the doctor with less tablets than when we went in with. I know some patients who have to take as many as 30 tablets every time and the very thought sends shudders down my spine.  I have seen it with my own father. He starts retching when we give him all his tablets. It is horribly distressing to see. The very thought of getting older and sicker terrifies me for this very reason.

We as doctors are very quick to prescribe tablets but rarely ever see how inconvenient and uncomfortable it must be for the patient to have to take those tablets. Each tablet comes with its own costs - both financial and in terms of side effects. When a patient develops side effects, rather than really appraising whether the medication is truly worth giving, we just get on give the patient more medications to counteract the side-effects! We feel happy that we have managed to do something so that we can get the patient out of the door as quickly as possible without having to do much brain-work,  the pharmaceutical industry licks their lips because they are selling more product  , the insurance company employees give each other a fist bump because they can raise premiums and all this happens at the expense of the central and ‘supposedly’ most important figure in this equation  - the poor patient. 
When this poor patient finally musters up the courage to challenge why they have to take all these medications, they are often met with a curt response - ‘because they are good for you and if you don’t take them it is likely something bad will happen to you’ and so with this fear instilled in their mind, the patient is sent on their merry way with an appointment in 6 months. The patient will then continue to take the tablets, feel completely helpless, continue to suffer and will never ever even know whether they have even benefitted from some of those medications. 

The reality is that this is the easy answer to give. Most doctors give medications because they have been ‘told’ that it is good for the patient. Most doctors have no idea ‘how good’ and even more importantly, whether what they know about the supposed goodness of that medication can be extrapolated to that unique patient in from of them.

This is to my mind is  bad medicine. Whilst medicine is commonly seen as a science, the practise of medicine should be an art. 

What we should be doing is seeing that patient as a whole being and not as a list of diagnoses. We should understand that more important than any tablet is the level of rapport and trust that they share with their doctor. When a patient asks us why they are having to take a particular medication, we should really try and evaluate exactly how beneficial that medication would be for that specific individual and we should take into account their unique situation, their age, the impact that the medications are having on their quality of life and most importantly their wishes. Then we should always give the patient the choice and say ‘these are what the data say and these are the numbers - do these numbers work for you and if the patient says they do then you have a more empowered patient who can own that decision to take that tablet and if the patient says no, then again you have an empowered patient who feels like he has made the decision that is best for him (or her) and we need to learn to respect that. It should always be about the patient and we should give them that respect that they deserve. 

One of the things I wanted to do on this channel is start presenting what we do know about commonly used cardiac medications in a manner that makes sense to patients. 

Here is a general common-sense based template to use when thinking of pills.