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with Rod Moser, PA, PhD

Stories from behind the examining room door, as told by Rod Moser, PA, a primary care physician assistant with more than 35 years of clinical experience.

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Wednesday, August 17, 2011

Men and Medication Noncompliance

If medical science ever created a male birth control pill, it would never work. Not only would men fail and/or forget to take it, they would lie about it.   Men just do not like to take pills…any pills. Period. Sadly, I am no different.

In the last week or so, I have been on fairly high doses of prednisone, a potent steroid, in order to control my polymyalgia rheumatica (a fancy medical term for an autoimmune disorder where every muscle and bone in your body hurts).  I think the term is Latin for “feels like crap”. Why this surprise illness happened to me, I have no idea, but it did and I have to deal with it.

As a seasoned medical provider — one who harps constantly at my patients for doing the very same thing that I do — I feel like a hypocrite. It is very important that prednisone be taken in a certain way, on time, and every day. For the first week, I was doing great and feeling great, but yesterday, I forgot to take my medication. Today, I feel like a truck ran over me again. It’s my own fault. Pain is just one of the body’s many reminders of our human fallibility.  I have told my patients over and over, until I am blue in the face, that studies have proven that medications are inherently ineffective when left in the bottle.

I have the same problem with antibiotics. On those rare occasions where I must take them, I have to get my wife to help remind me after a few days. Granted, I am the king of multitaskers, but failure to comply with an antibiotic regime is something that I fight as a personal demon. I will delay starting antibiotics on purpose, hoping I will “just get better” so I won’t have to try to remember to take them.

We can quickly generate a lot of excuses for medication noncompliance, but none will hold up in the Court of Common Sense. I know that some woman have noncompliance issues, too, but I can only speak from the perspective of a man — a man who is both medical provider and patient.  Women are just better pill-takers and that’s the end of the story.

Maybe it’s the purses? Women pack a lot of stuff in those bags. I have seen complete pharmacies emerge from those tissue and cosmetic-filled satchels should another person ask for a headache medication or something. Maybe women are more accustomed to rituals? My wife goes through a systematic dance every morning that involves a variety of creams, make-up, sprays, ointments, moisturizers, deodorants, and perfume. Maybe it stems from birth control? Sexually-active women who do not want to get pregnant or delay pregnancy will learn to take birth control pills. Their motivation for compliance is quite obvious.

Parents (usually includes a man in the mix) are responsible for seeing that children take their medications as directed. Knowing this, men who bring their children to me for care often beg me to “just give ‘em a shot” so they won’t have to be hassled by a ten-day course of therapy. While injections may be an option for certain diseases, I usually tell them that they have to bring the child back every day for ten days for a daily shot, so they stop asking me. The fearful kids, hearing Dad’s request, will often high-five me on the way out of the room.

I have several of those little plastic pill boxes, and my medications are preloaded. All I need to do is open that little hatch, dump them in my hand, and swallow them with water. Sounds easy, but apparently it is not. Somewhere deep down inside men exists a dark barrier — an aberrant gene, perhaps. I should try to get a federal grant and study this.

A few years ago, you could register your name with a particular pharmaceutical company, and they would actually CALL YOU to remind you to take your medication! I suppose they could send you an e-mail or a text message, too, but reminders are just reminders. You still have to take that last and most important step — Taking the Darn Pill!

I guess I am frustrated with myself. My ultra-short term memory isn’t what it used to be. I can remember my grandmother’s phone number from 1956, but I can’t seem to remember why I came into a particular room. Of course, soon as I leave the room, it comes back to me. My long term memory is selective. I don’t have any idea what my cell phone number is.  Yet I can see 15 different patients in the morning and only write down a few, cryptic notes to jog my memory, and I can recall the complete visit like a movie. I tend to chart on my morning patients over lunch time, when things are quieter and less-chaotic. I feel that my chart notes are superb. We have electronic medical records and a computer in every exam room, but I refuse to put a big flat screen between me and a patient and type while they are talking to me. While this may be time-efficient, I find it rude, so I won’t do it.

So, maybe noncompliance all comes down to priorities. If you know something is important, you are more likely to remember it. For all of my patients, some of who read my blog, I apologize for chastising them for not following a medication regime to the letter.

Remember the excuse that all people who set bad examples use: Don’t do as I do…do as I tell you.

Let’s all do better.

Posted by: Rod Moser, PA, PhD at 11:52 am

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