Do your patients take your advice?

March 3, 2006

This doctor reveals why she'll keep doing her job—despite patients who eat cheese and don't listen.

As a family physician, my specialist friends often tease me, "Don't you get tired of talking about the same old stuff? You're not really changing anyone!" I know it's a lot of "Watch your cholesterol, lose a few pounds, you need to quit smoking, let's get that blood pressure down. . . ." I'll be the first to admit that the day-in, day-out job of a family practitioner isn't the stuff of television dramas, but my oft-repeated words could potentially save lives-that is, if my patients took my advice.

I leave the room at the end of a patient's yearly physical feeling good. Most patients leave smiling. But does my guidance merely go in one ear and out the other, or do they actually follow through on my instructions? The optimist in me likes to think they heed my counsel, but the pessimist-or realist-in me seriously doubts it. Pondering whether or not patients listen to my recommendations is always in the back of my mind, but I was recently reminded just how much in vain my efforts may be.

After gearing myself up for the fourth well-woman checkup in a row, I entered the exam room. The 54-year-old patient had a beautiful head of silvery hair, shining eyes, and a bright smile. I'd never met her before, although she had been a patient in our practice for some time. After I introduced myself and we exchanged a little small talk, I dove right into my usual questions. The words started flowing robotically out of my mouth.

"Shortly after the turn of this century," came the good-humored reply.

Of course, I told her she should have one every year or two. She caved and promised to get one. We talked about the need for calcium supplements and then moved on to a lengthy discussion of HRT. She'd been taking estrogen since her hysterectomy-10 years earlier! I explained the risks and how it's best to take the lowest effective dose for the shortest amount of time to abate her symptoms. The mere thought of cutting back made her panicky, but she did agree to revisit the issue again soon. Then the conversation took a truly comic turn.

"Now let's get to those other medications you're taking. Which are . . . ?"

"Oh, now you're really going to yell at me," she said. "I was in here about six months ago and the blood test showed that my cholesterol was high, so I was started on Lipitor."

"Uh huh."

"Well, I bowl a lot and, a few days after I started the Lipitor, I threw my arm out bowling. I made some sort of mental connection between the two and decided I didn't want to take the Lipitor every day."

"So, you stopped taking it? Why didn't you let us know you thought you were having a problem with it?" I asked.

"I didn't think to call. Is it really that big of a deal? And I didn't stop taking it completely."

"I see. So, then how are you taking it?"

"You'll laugh at me," she said.

"No, I won't."

I think, I can't wait to hear this.