Seems that I spent a lot of time discussing side effect issues with medications with patients this week. I get that people are concerned about what’s going into them and what badness might happen, but they forget to ask about the positive things that might happen as well.
There are risk/benefit ratios for everything we do in life, be it something we say to someone, something we eat or drink, some action or inaction, all can result in positive or negative effects. Medications are no different. Everything we do medically is calculated, based on evidence, training and experience. We cross reference this with what is wrong with the patient, what they’re taking, what other problems the person has, and what other medication they are taking. The more the person has going on and is taking, the harder the decision becomes.
Then there comes the other problem of mis/disinformation and plain old ignorance about what various medications do or don’t do and the frequency of said issues. The internet is a great thing if used properly…however, many people have a habit of not reading good sites. Another problem is Dr’s Mom and Friend Who Knows Everything (yet has no medical training) – I often hear people saying that their friend or mom says that they need this, that and everything else. Rarely true.
Back to the problem at hand – person comes in with complaint X and is found to have diagnosis Y. Treatment options include A,B,C and D…however patient is deathly allergic to A, and C and/or D aren’t likely to be effective without B. Since I can’t make someone do anything against their will (well, almost anything), my job now is to let the person know what I think is best for them and why. I don’t hand hold – I’m blunt about options and what I think the best ones are for that person at that time. I’m also blunt about concerns about minutiae that may or may not happen, especially side or adverse effects that happen one in a bazillion times – and for some reason, most people think that those will be the ones that happen to them. You have to be blunt in the ER because you can’t hold onto folks that don’t need to be there. Some folks will all of a sudden develop a decision making disorder about what’s really a minor issue and blow it all out of proportion, expecting family to convince them, as well as me, that this is in their interest. Luckily for me in this case, I’d had a similar intervention and was able to speak from experience from both sides of the fence and we got down to business shortly thereafter.
Side effects or adverse effects occur sometimes, but not near as often as people think. Ask your questions, sure, but also ask balanced ones, “Like what are the benefits as well as the risks?”.