This is a true story, and I'm not exaggerating. A long time ago, I was at McDonald's and the customer in front of me said, "I would like a Whopper." The McDonald's worker said they didn't have a Whopper. The customer then said, "Well, how about a Whopper Jr.?"
This customer got very angry at the McDonald's worker and yelled, "Well, then what the hell kind of hamburgers do you have?"
I said to this irate customer, "This isn't Burger King." He replied, "So, what! I want my Whopper!"
This guy probably looked for milk in a hardware store. Is that why some patients don't take their medicines?
Noncompliance means a patient doesn't take his/her medications or doesn't follow through with a medical treatment plan. A large U.S. study has shown that only one half of hypertensive patients take their blood pressure medicines. One half! That's like saying only half of the cast of Friends appears on each episode, half the Brady kids perform a reunion special, or half the American Idol judges show up to say anything (we can say that since Randy Jackson has lost all that weight).
There are many reasons for noncompliance with medications. The one I want to focus on is priority. For most patients, medicines are as popular as Vanilla Ice.
I have heard numerous patients say, while talking on their cell-phone-PDA-wireless-iPOD-camera-Mercedes-starting-hand-held device, they cannot afford their medications. When I lived in L.A., I had several patients who drove Rolls Royces, but they couldn't pay for their medicines because they had to pay car insurance.
So when I see someone win a car on Wheel of Fortune, I just think to myself as I contemplate her new insurance premiums, "There go her diabetes prescriptions."
So when I have patients who can't afford their medicines because they spend a fortune on cigarettes, beer, and shoes (though the shoes are the most forgivable), I feel like I work at Lowe's and someone wants skim milk. What am I supposed to do? I'm like Batman without the utility belt.
I have asthma patients who smoke and expect me to help them breathe better without medications. When I strongly recommend they quit smoking, I usually get a look that could freeze ice on a hot summer day: "Quit smoking? That's un-American."
I have patients with ulcers and heartburn who won't stop overeating, smoking, and drinking. "Doc, I don't believe in medications. So what can you do to stop the pain?"
I respond, "Aren't tobacco and alcohol like medication?" "No, they're natural." Well, so is hemlock.
I have diabetic patients who complain to me they don't want to take medicines, and they want to strangle me each time I mention exercise and eating right. "Exercise is soooo '80s! Can't you put a wick in my navel, light the flame, and have the fat burned off?"
I have had my share of patients with frequent migraines who are opposed to taking a pill every day to prevent migraines. But, boy, they don't complain having an IV filled with morphine put in their arm in the emergency department.
"I didn't think I would have another migraine," such a patient says. "This is your tenth ER admission in a month," I respond. "So who's counting? Details, details."
Not everything needs pills, but when a pill is indicated, complaining to a doctor doesn't work if you're noncompliant. But some people want their Whopper regardless of the restaurant. Personally, I would ask for escargot and crème brulee.
Got a medical question? Dr. Hook wants to hear from you.
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[The headline supplied with the print version of this story contained a grammatical error caused by the copy desk; it has been corrected in this online edition–editor.]
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