It's all about youIt goes without saying (but I'm saying) that a physician can't properly care for his or her patient using false or missing information. The truth, the whole truth, and nothing but the truth are absolutely essential, down to every last detail—even details that seem trivial or unimportant. Here's a quick example of a health threat that doesn't seem like one—a detail easily overlooked, forgotten, or deemed incidental when a patient discusses diet with his or her doctor.
Danger! Grapefruit?Yes. In the category food-drug interactions, certain enzymes in delicious, bracing, vitamin-rich grapefruit juice can cause your body to absorb way more of a drug—for example, widely-prescribed blood pressure and cholesterol-lowering statin drugs. Result? An overload of the drug in the body, with the increased risk of side effects, from mild, such as muscle and joint pain, to severe, including muscle fiber breakdown and kidney failure. Grapefruit isn’t alone on a long list of dangerous food-drug interactions, such as combining the anti-clotting blood thinner Coumadin and leafy vitamin K foods that promote clotting. Talk about cross-purposes. There are also combinations that fall into the drug-drug interactions category:
- Drugs for high blood pressure and OTC nasal decongestants don't mix. The combination can actually raise your blood pressure
- Tylenol and alcohol taken together can harm your liver
Be your own best data sourceTo that end, for every doctor visit, you should have ready a pre-appointment dossier that's all about you—including all the details of your diet, every med or supplement you're taking, and why you've made the appointment, in the first place. Regular checkup? Pain? Insomnia? Joints hurting, stomach misbehaving, vision blurry, unusual or habitual fatigue? Be sure you include information on your physical activity—no matter how insignificant it might seem. If you're sedentary, for example, the extent of your activity is by definition limited. But that's important! When your doctor knows you're desk-bound or couch- bound, he or she can help get you up on your feet more often, an easy step at a time, instead of leaving you with the vague directive to "get more exercise?" And don't omit any stress factors in your life. That stuff kills. Even the everyday stuff we all get stressed about—spell it out. And for heaven's sake, don't omit your meds and supplements. You've already seen examples of drug-drug and drug-food interactions. Be assured the lists are far longer and the hazards more consequential than what I've just showed you. To put it all very simply, the more your doctor knows about you, the more he or she can help you. Help him or her and yourself by preparing. With so much at stake, why, returning to my opening paragraph, in the world would anyone not be fully truthful in helping to manage his or her own health? What's the motive to lie or omit?
Shame, shame, shameResearch has shown us that patients will lie about symptoms in order to qualify for government disability payments, to get a more helpful insurance payment, to get drugs they don’t medically need, or to protect someone—an abusive spouse, for example. Or sometimes they’re just plain embarrassed because they know they should be doing something that they’re not (eating better, exercising more, taking prescribed medications)…or they know they shouldn’t be doing something that they are (smoking, drinking too much alcohol, etc.). That's basically gaming the system, and it's not without risk outside of the therapeutic context, including that legal action. Among patients who are simply interested in their health, research shows that they most often lie about:
- Drug or alcohol use
- Sexual activity
It's all about you ... and maybe millions of others?There's another important reason why patients should always tell the truth and the whole truth. Incomplete or inaccurate information has serious ramifications, both within and beyond each single doctor-patient relationship. These days, electronic health records (EHR), collected by physicians and clinicians, are sent off into any number of databases, where researchers can detect trends and/or anomalies that can help the entire universe of patients. In other words, a single lie, or some overlooked, unreported information, can have global impact when it's multiplied thousands or millions of times. For example, I read of a doctor who didn’t believe his patients’ ethnicity was important when entering their information into his electronic health record system. So, by default, he labeled them all as Albanian since it was the first ethnicity listed in the drop-down menu on his record-keeping software. Now, if researchers pick up a health trend in this doctor’s California county, it may be skewed since roughly 90% of his patients are listed as Albanian. Make sense?
So how do we doctors help patients shed their fears and concerns?Sad to say, we physicians should never just assume that we're getting all of the information we need for patient care. Nor should we just assume that a patient fully trusts that their information will remain confidential. I believe these issues must be proactively addressed at the start of every contact with every patient, sort of like when a law enforcement official has to read an arrested person his or her rights. "As your physician, I'm required by law to keep all information you give me confidential and to remove any personal, identifying information about you if your medical history may be used for medical research from your record ... " Like that, only shorter. Still, and an ongoing concern, let's note that research found that 19 percent of patients would be 100 percent honest
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- "Do Your Statins and Grapefruit Safely Mix?" Cleveland Clinic. Published January 20, 2016. Last accessed June 8, 2018.
- Burns, Shauna B., Kelly, William N. "10 Drug Interactions Every Pharmacist Should Know" Pharmacy Times. Published November 1, 2002. Last accessed June 8, 2018.
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