October 25, 2013
When I visit my doctor, she comes into the examination room ready for battle. I research and write about drugs and medical devices for a living — my doctor knows this.
She usually tries to put me at ease with pleasantries and a simple, “How are you?” I smile and reply, “Great, how are you?”
But I, too, am gearing up for a fight. I’m already preparing to protest whatever medication she tries to suggest, and when we go over test results, the push and pull begins. She knows that I will not simply take her advice without raising an eyebrow and asking a plethora of questions.
I am one of those patients who doctors probably dread.
An article on CNN.com shows doctors actually complain about people like me. In their eyes, patients who take the time to educate themselves are less compliant.
In my case, this is 100 percent true. After all, when it comes to health, informed decisions are the best, and I refuse to do anything simply because someone tells me to. This includes my doctor.
Besides, even if my doctor doesn’t mean to exclude information, I know that sometimes what doctors know is based on pharmaceutical company studies which can be biased.
Recently, I had some dizziness and fatigue. I had been moving into a new house and anyone who moves knows how stressful the whole process can be. I thought, maybe, it was just stress. But I visited my doctor just to make sure it wasn’t anything serious.
My blood pressure spikes at the doctor’s office. It’s an actual condition that doctors call “white coat” syndrome. All the things I know about drugs and medical devices don’t help relieve that stress.
Normally, I leave work and try to leave this knowledge behind, but I can’t ignore it when I am sitting in the doctor’s office facing the possibility of having to take medication. But while my doctor probably views me as overly cautious, my concern is founded on well-researched evidence.
For instance, the FDA only requires clinical trials and testing for class III (high risk) medical devices. Unfortunately, the majority of devices fall in the class II category. These include hip implants and surgical mesh that don’t require testing, even if they are intended for long-term implantation in the human body.
Drugs that people take for chronic conditions, such as type 2 diabetes, high cholesterol and blood thinners, have underreported side effects, including the risk of bladder cancer, poor sugar control and uncontrolled bleeding to name a few. Some of these drugs are also put through a fast-track approval process.
My doctor knows my blood pressure history and during this last visit, she was concerned enough to order an electrocardiogram followed by a sonogram of my heart because my heart, “pumps to the left,” she said.
If there is thickening in my heart caused by stress-induced high blood pressure, she may consider treating me with an SSRI for anxiety, a drug for high blood pressure or maybe both.
Neither option sounds appealing.
Diagnosis and Treatment Options
The tests results come back positive for a slight thickening of my left ventricle. Instead of scheduling me into the office for a full consultation, my doctor called me a couple of days after the test.
“I want to get you started on blood pressure medication,” she said. “The slight thickening in your heart concerns me.”
The medication is a 50mg dose of losartan, also known by the brand name Cozaar. She mentioned it had minor side effects, the usual headache, nausea and dizziness. She also said she was giving me a “baby dose.”
I immediately started researching the medication and found a number of things the doctor failed to mention.
For instance, the drug has an FDA black-box warning for birth defects and death in fetuses, if taken during pregnancy. Taking potassium supplements or too much potassium with the drug can cause toxicity in the body. It is also not recommended for people who take NSAIDs. The dose I was given is not the highest dose, but neither is it the “baby dose” she was referring to, which would be 25mg.
There are also a number of patient sites where people who took the medication rate the drug, and share their experiences. It turns out the drug is given decent reviews, and the number of people who complained about side effects isn’t too bad.
A quick check for FDA adverse events didn’t turn up anything significant. I also read how the drug works in the body, and what it is approved to treat.
Knowing if the drug you are taking is actually approved for treating the condition you have is important. Off-label prescriptions are not illegal. It is up to the doctor to decide if using a drug for a condition other than its approved use is right for the patient.
Generally, off-label prescriptions can be risky. In the case of the INFUSE bone graft, doctors were reading studies that actually recommended off-label use, but a number of side effects were not properly discussed in these studies. A great number of people ended up suffering problems, and filing lawsuits as a result.
The drug I was prescribed is approved for a couple of other uses besides high blood pressure, including a condition known as left ventricle hypertrophy. It turns out this is the actual name for the thickening of the left ventricle which my doctor did not explain or mention.
Armed with this information, I felt comfortable giving the drug a shot. But this was all information I had to look up on my own.
Trust Between Doctor and Patient
In the end, it all comes down to trust shared between doctor and patient.
Patients wonder if their doctors are telling them what they need to know. Doctors sometimes decide not to tell patients everything for a number of reasons. If a bond of trust isn’t developed early on, this can concern a patient. Plus, some doctors who work too closely with drug companies and take money from them have poisoned the well for a number of other doctors.
Doctors also don’t trust their patients to follow instructions or take their advice.
The bond between doctor and patient can be improved by communication. Concerns should be laid out on the table and both parties need to listen.
When I visit my doctor for my follow up appointment, I am sure we will have a great conversation. I may even be compliant.