Options

Today I spent some time chatting with a patient about various options to treat a condition. This disease is slowly progressive and should be treated to prevent complications down the road. If a patient is in good health, it’s especially important to treat since there will be many years in which to develop complications. If a patient has many medical problems and is not expected to survive for more than a decade we can focus our efforts on more immediate concerns.

This patient and I had spoken by telephone after another physician had noted her condition. The other physician had recommended a reasonable course of action but the patient wanted to discuss things with me. The patient and I discussed various options and I encouraged the patient to do her own research and then come in for a face to face meeting.

The first option we discussed is not to do anything. I told the patient that this was not acceptable to me since she was young and in good health: she potentially had forty years to develop the full spectrum of symptoms. The remaining options include three different classes of medications. Each class had its own set of risks and benefits and we discussed them all.

I was very surprised to hear the patient’s initial choice of medication since the risks far outweighed the benefits. When I asked her about the choice, she said that “everyone” said it was the most effective. “Everyone” had problems with the other two classes. And who was everyone? No one that the patient knew or had spoken to – it was all Internet chatter. It was as if there was a Yelp for pharmaceuticals. The comments were almost laughable but were being taken very seriously by my patient and therefore needed to be addressed.

At the end of our conversation we agreed upon an initial three-month plan. If things work out well I hope that she will consider taking medication for a number of years. I directed the patient to some well-vetted medical information sites and asked her to consult with me before making any changes in her medications and not to be distracted by “everyone.”