Honesty is the best policy. Or is it? In medicine, it is.
A challenge I frequently encounter is a patient that consciously (or unconsciously) withholds information from me. There could be a number of reasons this happens, but I will the patient, “I don’t care what the reason is, just tell me what’s going on.”
Health care professionals get caught up in the ideal treatment or medication for a condition. What they should get caught up in is, “will this be something the patient will agree to?”
I can’t tell you why, but patients often tell me something to the effect of, “I didn’t want to upset the doctor” or, “I didn’t think that was important to mention” when I casually interrogate them after they’ve seen their PCP.
For the patient: Please don’t do this. If a doctor, therapist, nurse (etc etc) suggests something and you don’t want to do it, tell us. We will come up with another plan. If a new medication or treatment has a side effect that leads to its discontinuation, tell the doctor immediately to prevent a future emergency.
There is always the potential a condition doesn’t come with many options, but at least we can treat in a way the patient can live with or discuss what the untreated complications will be.
For the health professional: Understand there is no one size fits all treatment. Know the common side effects of treatment and the objections patients frequently give. Ask the patient if they will comply with the plan.
Examples: Furosemide has the intended effect of increased urination. If the patient is not made aware of this, or the reason we want excess fluid removed from their body, they are likely to discontinue the medication. They may be incontinent rushing to the bathroom, it keeps them up at night, or it’s just a hassle they would rather not deal with. If they are not well informed on the reason they have been prescribed the medication, they won’t think twice when they stop taking it.
Regular release Metformin comes with the common side effect of GI distress. There is a reason this was prescribed to help manage diabetes. However, if the unwanted side effect is communicated to the doctor, an extended release (usually a little more expensive) can be ordered.
Again, dancing around the issue of non-compliance doesn’t hurt the health care professional. Patients, honesty will get you appropriate quality care faster.