"Patient-reported medication symptoms in primary care."  This was published
by the Archives of Internal Medicine, Volume 165, No. 2, January 24, 2005,
and mentioned in the People's Pharmacy column today.

At first glance, it should be a big DUHHHH (perhaps meriting its own
Doctoring for Dummies book), but unfortunately it is not only an important
consideration in medicine, but too infrequent for quality care.

I attended a seminar on Medical Ethics (illustrated by the case of statins)
last week at UCSD, and I was struck by one doctor (a ranking member of the
medical college, both a physician and a lawyer) who absolutely categorically
stated several times that he DID NOT BELIEVE that physicians would tell
patients that it was "impossible" that statins could be responsible for the
adverse effects they were experiencing.  Unable to contain myself, I spoke
up from the audience and, holding up printouts from 5 different emails that
I had personally received just in the past week by people who had heard just
such pronouncement from their own physicians - each of whom refused to even
consider statins as causitive in the symptoms the email author or his/her
loved ones were experiencing, even though all of the symptoms were well
documented in the medical literature as known statin adverse effects.  To
this the dubious doctor said that, while he didn't doubt the PATIENTS
claimed the doctors said it was impossible, he did not believe that the
doctors ever said "impossible."  To this the presenter of the ethics seminar
said that, while she would have been inclined to agree with his opinion
several years ago, having consulted with several of these dubious physicians
(at the patients' insistence), she no longer doubted the patient reports
that their doctors said it was "impossible."   Disturbingly, the opinionated
doctor (who instructs other doctors and doctors to be in medical school)
then said, I do not believe you.  Effectively, branding not only the
presenter, but all the patients referenced, liars.

Naturally, this was disproportionately disturbing to me, as there had been
***AMPLE OPPORTUNITIES*** for intervention during the 4 year decline on 10mg
Lipitor when my husband's growing constellation of symptoms, increasing in
severity, had been repeatedly discussed with his Primary Care Physician and
his Cardiologist.  Never once did either of them relate these symptoms to
the statin (exception: Muscle pain, he was told it was the statin, but to
"tough it out"), nor did they explore other causes (exception, near the end
of the 4th year, there was a carotid artery scan done at my insistence to
eliminate a blockage of blood flow to the brain as a cause - it was clear
and nothing else was done).

It was from this perspective that this morning's People's Pharmacy reference
struck me as important.  Here, without further introduction, is the
abstract:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra
ct&list_uids=15668373

Arch Intern Med. 2005 Jan 24;165(2):234-40.

Patient-reported medication symptoms in primary care.

Weingart SN, Gandhi TK, Seger AC, Seger DL, Borus J, Burdick E, Leape LL,
Bates
DW.

Division of General Medicine and Primary Care, Beth Israel Deaconess Medical
Center, Boston, MA, USA. saul_weingart@dfci.harvard.edu

BACKGROUND: Little is known about the prevalence and character of
medication-related symptoms in primary care and their relationship to
adverse
drug events (ADEs) or about factors that affect patient-physician
communication
regarding medication symptoms. METHODS: The study included 661 patients who
received prescriptions from physicians at 4 adult primary care practices. We
interviewed patients 2 weeks and 3 months after the index visit, reviewed
patients' medical records, and surveyed physicians whose patients identified
medication-related symptoms. Physician reviewers determined whether
medication
symptoms constituted true ADEs. We used multivariable regression to examine
factors associated with patients' decision to discuss symptoms with a
physician
and with physicians' decision to alter therapy. RESULTS: A total of 179
patients
identified 286 medication-related symptoms but discussed only 196 (69%) with
their physicians. Physicians changed therapy in response to 76% of reported
symptoms. Patients' failure to discuss 90 medication symptoms resulted in 19
(21%) ameliorable and 2 (2%) preventable ADEs. Physicians' failure to change
therapy in 48 cases resulted in 31 (65%) ameliorable ADEs. In multivariable
analyses, patients who took more medications (odds ratio [OR] = 1.06; 95%
confidence interval [CI] = 1.04-1.08; P<.001) and had multiple medication
allergies (OR = 1.07; 95% CI = 1.03-1.11; P = .001) were more likely to
discuss
symptoms. Male physicians (OR = 1.20, 95% CI = 1.09-1.26; P = .002) and
physicians at 2 practices were more likely to change therapy (OR = 1.24; 95%
CI
= 1.17-1.28; P<.001; and OR = 1.17; 95% CI = 1.08-1.24; P = .002).
CONCLUSION:
Primary care physicians may be able to reduce the duration and/or the
severity
of many ADEs by eliciting and addressing patients' medication symptoms.

Publication Types:
   Multicenter Study

PMID: 15668373 [PubMed - indexed for MEDLINE]

So, as many of you have seen in most of my posts, if only the adverse
effects were more widely known, and if only doctors would screen for them,
others need not become disabled due to statin adverse effects.  A simple
message, now worked up as a study.

Unfortunately, the situation persists.

And unfortunately for patients, doctors-to-be are being instructed by
doctors like the one in the audience of the ethics seminar, who is so deeply
in denial as to ignore evidence all around him (and at least he attended).
It is little surprise that that particular physician felt the need to attain
a law degree to go with his medical credentials - one wonders if it would
have been a perceived need had he spent the hours listening to his patients
that he instead expended at law school?