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This week I’ve had a number of patients come in missing both their statins but also other medications. I’d like to talk a little bit more a bit more about this because it’s a really important area. Often what tends to happen is that patients would come in and report that they have had a symptom that they believe is a side effect.

Well, that’s a pretty important thing.

Sometimes however, they will attribute that side effect to a particular medication and stop it. They do this without discussion and without involving the doctor in that decision-making process.

Some patients will just run out of the medication so if they, for example, have been in hospital and a particular medication has been started then the discharge script for that medication lasts a month for example, when that month runs out some patients will believe that they finished the course of therapy that they are required. True perhaps for antibiotics but not usually for other medications. So, it’s really important to check what is the case, perhaps a lifelong preventative strategy or if it is a course to be clear about that.

Some people just forget to take their medication. That can happen. It’s very hard to focus that priority.

My observation is if someone’s had a heart attack, for example, they are more likely to remember their medication, than, for example, someone who has mildly elevated blood pressure who feels perfectly well and doesn’t like the idea of taking tablets.

Lastly, some people will read information on social media and again make unilateral decisions about what care they should be on without engaging the doctor who prescribed their medication in a conversation about it. I think it’s very very important to understand that the best way to deal with this situation is to understand the risks that could be associated with taking a particular medication and the benefit for that individual and understanding that the risk that exists with any medication is a risk of side effect. Remeber different patients will have a different benefit and statins are a very good example of this. There is no question that any medication including statins run the possibility of some risk to the patient.

For statins, a side effect may be muscle aches and pains. This possibility of a side effect is common for almost any medication whether it’s Panadol, aspirin or even water, too much water could give people a side effect. Well, we have to weigh up the drugs we use against their therapeutic doses and effects. Does the risk of a particular agent balance up or is it outweighed by the benefit it can offer that individual patient? I believe this is where the conversation needs to be specific to the individual who we’re dealing with.

In regard to statins, there is no question that in secondary prevention, which means people who’ve had a heart attack or an event like a heart attack, we have clear evidence from multiple studies that lowering those people’s cholesterol reduces future risk of the event.

This is really important. It’s really robust and it needs to be really clearly communicated to the patients so they understand the objectives of the doctor. In other areas, the benefit and the risk equation are harder to be sure about, and so harder to articulate to the patient.

Consider the situation of blood pressure, many patients will feel perfectly well, though blood pressure might be borderline elevated. They might be carrying a little bit of extra weight. They may not wish to take a tablet or could be one of the groups of people who say I just don’t like tablets. These people may find that the risk of a blood pressure tablet is not going to really provide the benefit that they want in their perceived view of their health. This is where they can have a clear and open discussion with the prescribing doctor. This is really important so that the objectives the doctor is trying to achieve can be articulated to the patient and the patient be part of that decision-making process. I think it’s really important in that space to recognize what the aim of the doctor is providing that recommendation for treatment. For the borderline hypertensive, weight loss and review of blood pressure levels may be the plan that the doctor and patient settle on.

The aim will generally be a better outcome for the patient either in terms of symptoms or prognosis. Symptoms are really clear-cut. So if a patient misses a medication that’s related to symptoms then they will be more symptomatic. So the link between the medication and its effect is pretty straightforward.

The conversation is more complicated generally in a prognostic situation so where the patient takes a medication to prevent an issue that could occur a year or two or 10 years down the line. This is where the immediacy of the effect of the agent is nowhere near as clear and where education and explanation is absolutely paramount to engage patient in the process.

I deal with patients who have very elevated cholesterol.

These are people who may come from families where there is high cholesterol and premature coronary disease throughout the family. So familial increased cholesterol of people within families....we call this Familial Hypercholesterolaemia. There’s no question these people can have the risk of a heart attack reduced in decades to follow by starting their cholesterol therapy early. The trouble is they will only take their medication if they fully understand the benefit it will provide to them because without an explanation of the benefit all they see is the risk (the side effect of the medication). From my perspective I don’t wish to force people to take something they don’t want to take nor do I want to force tablets on people who don’t need them. I have no desire to simply write out scripts and hand out pills. What I do have is a deep desire to make a meaningful difference for individuals based on their particular needs and matching their particular need with the appropriate therapy for them.

That’s why a conversation with the individual and their particular needs is so important and for my patients, particularly the ones who have made decisions about unilaterally stopping drugs. Apart from letting them know that I’m a bit upset about that, what I really try and do is invite them to be engaged in the conversation about what we’re trying to achieve how we’re trying to achieve it, and if there are troubles with the medication, how do we find a solution that best suits that individual.

It is a complicated area but what I really encourage you to do is not find this path alone. What I really encourage you to do is engage with your doctor or the person who prescribed that drug to discuss the best way, the unique way to find the solution that best works for you. The very starting point in all this is education. The second point is communication and they go side by side. I really hope this gives you second thoughts about stopping medication. I think I really hope it gives you second thoughts about engaging your doctor or your prescriber whatever medications your on. Lastly, I really hope it reminds you of what we’re trying to achieve on this side of the desk is the best outcome for you in the long term. It’s up to us to articulate that clearly and explain it to you clearly so that you are engaged and part of that process. I wish you the best of health.

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Understandably, Dr Bishop is unable to provide individual patient advice over the internet due to the complexity and importance of health related issues, further, Australian guidelines prevent professional specialist advice being offered without appropriate referral.

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