Patients with "difficult-to-treat" asthma often turn out not to be taking their medication regularly.
Self-sabotaging patients. I'm Bob Hirshon and this is Science Update.
If an illness won't respond to medication, maybe the patient isn't taking it. That's the upshot of a new study in Northern Ireland, led by Belfast City Hospital pulmonologist Liam Heaney. He and his colleagues looked at over 180 patients with hard-to-treat asthma, many of whom had been hospitalized. His team tested their blood for the meds, and checked to see if they'd picked up their prescriptions.
Although they had denied, or not admitted to, not taking their medication, when presented with the data suggesting they hadn't been picking up their prescriptions, it became clear that that was in fact the case.
They found that a third of inhaler users weren't taking enough; for oral steroid users, it was closer to half. Heaney says the same may apply to other seemingly stubborn illnesses. I'm Bob Hirshon for AAAS, the Science Society.
Making Sense of the Research
In an early episode of TV's House, the cranky Dr. Gregory House said, "I don't ask why patients lie, I just assume they all do." He might have been pleased by the results of this study, although the real-life Dr. Heaney suggests a much less confrontational approach than the fictional TV doc.
The patients in this study had all been diagnosed with "difficult-to-treat" asthma. That's a catch-all term for asthma that doesn't seem to respond to normal medication. Many of the patients in the study had been hospitalized, some as often as three or four times a year. One would think that these patients would be doing everything they could to improve their symptoms and avoid more serious illness.
As the study found, this wasn't necessarily the case. When first asked, the patients in the study almost universally claimed to be taking their medication as directed. Because health care in Northern Ireland is very centralized, Heaney's team was able to access complete prescription records for all of the patients. These records clearly showed all the prescriptions each patient had picked up and when they got them. For an inhaled daily steroid, the researchers also could do an on-the-spot blood test to see if they were taking the medicine.
These two lines of evidence indicated that a substantial proportion of the patients weren't taking their meds as directed. When Heaney's team gently presented these patients with the evidence, he says they then admitted that they weren't taking their medicine as much as they should. Rather than accuse them of lying, he says the best approach is to ask for their help in reconciling the prescription records and blood results with what the patients say they're doing. When they see that they don't match up, the patients generally tell the truth. In fact, Heaney says that clearing the air actually seemed to improve the doctor's relationship with the patient, and made the patients more relaxed and open.
Unlike Dr. House, Heaney did ask the patients why they didn't take their medication properly. He says the answers were almost as varied as the patients themselves. Some simply forgot; others disliked the side effects; some were in marriages or relationships where the patient feared being abandoned, and felt that staying sick would keep their spouse or partner around. Because patient drug costs in Northern Ireland are more controlled than in the U.S., cost was not a major factor. In fact, Heaney says many of the patients who weren't taking their medications actually qualified for free prescription drugs.
This study has implications beyond asthma. Heaney suspects the same may be true of other chronic conditions, like diabetes, high blood pressure, or high cholesterol, that require patients to take regular medication or maintain a healthful lifestyle. It's human nature to want people to think the best of us, and people just don't readily admit to their doctors that they aren't doing what they're supposed to be doing. But this study suggests that finding a way to keep patients honest may save a lot of needless and expensive treatment, and prevent life-threatening complications.
Now try and answer these questions:
- What is "difficult-to-treat" asthma?
- How did the researchers establish that the patients weren't taking their medication?
- Aside from the reasons mentioned above, why else might a patient deny skimping on his or her meds?
- Do you think doctors should check patients' claims against hard evidence, even if the patient doesn't know about it? Why or why not?
In the New York Times Learning Network lesson plan Doctors as Detectives, students consider the investigative and detective work that goes into disease control. They then research specific diseases and simulate a doctor-patient diagnosis situation.
The Access Excellence activity Medical Consultation Role Play is designed to function as an authentic assessment after the study of the human muscular system. Students are given a patient with some background information and symptoms. It is up to a pair of students to diagnose their patient, and then inform the relatives of the patient about the condition. The "relatives" may ask probing questions and respond appropriately to good or bad news about the diagnosis. Real life skills are practiced as the scenario unfolds.