Compliance, adherence and nonsense

“Oh, sure I take all my medications, they are right there on the bathroom side-table, in yellow plastic bottles.”Ms. Jones and I are trying to figure out why her digoxin level is low (0.2) despite a healthy prescribed dose. “You don’t miss them now and then…?” I say, “Because I sometimes forget my blood thinner, you know, the one for atrial fibrillation.”“I’m on that one” she says confidently. “That’s the blue one that helps me sleep at night.”We agree that rivaroxaban and zopiclone are two different drugs, and that she has been mixing those ones up. “No, digoxin is the heart rate pill that you’ve been on for the last 10 years, the one that can cause nausea and diarrhea in excess.” “Oh, right, well I might have told the pharmacist I’m allergic to those, I mean, who needs diarrhea from pills on bridge night!”“Yes, but only in overdose, or if your kidneys are weak,” I remark, trying to salvage some respect for an ancient but sometimes handy medication. “Who is your pharmacist?” I ask, but Ms. Jones isn’t sure.“My naturopath told me about Ashwagandha, which has taken the place of some of my medication. And milk thistle. My pharmacist said Big Pharma don’t give you guys a kickback to prescribe them and that you don’t really understand acupuncture.”I reached for a glass of water.“Oh yes, eight tall glasses a day is what you need, to keep your kidneys flushed and your Reiki in balance.” There was a look of disbelief that must have been noticeable. “Did you measure my vitamin D levels? I’ve been told my are bones are strong and my skin turgor is remarkable.” “Well, apart from hypertension and cholesterol and atrial fibrillation, you are looking good for 69.” “There, told you so. Now just fix my humours because I’m breathless climbing stairs. How about an inhaler? My neighbour, Janet, has three (blue, green and yellow) and she swears by them. She lent me one of her antibiotic pills too, but it caused a dreadful rash.”“Not MOXI . . .”“Sounds right . . .” She said it was a red and black capsule. I wrote “check for penicillin allergy’” in her file.I was planning to go over her vaccination status and I glanced at the clock. 12:35pm. I wondered if the afternoon might turn out better but had doubts after missing lunch.“COVID booster?” I asked, quietly—and was quickly educated that (a) the virus has gone (b) vaccines cause autism (c) her immune system is robust (d) it took eight weeks for her knee swelling to go down after her flu shot last year.“So, I’ll take that as a NO, then,” and she stared at the ceiling with one of those “give me strength” looks.“OK, Ms. Jones, I think we need to agree on what science has proven to be true, and what commercial adventurism and the unregulated internet has suggested as alternatives. Are you with me on that?”She told me her granny, who lived to be 80, was adamant the chicken soup was a key factor in her longevity (dementia aside). I nodded agreement; diet and exercise are valuable players in maintaining health. She has 14 steps up to the first floor, and another 16 to the rooms upstairs, and when she goes out shopping add 1,524 steps more. My tummy rumbled and my hand started to shake.“I know you don’t smoke” I chipped in, on a positive note. “No way. I was two packs a day until I turned 52, and the house burned down. Never again, my father said.” We celebrated her good fortune, but not with Jack Daniels.“Right Ms. Jones. I’ll cut back on some of my pills if you cut back on some of yours, agreed?” “Sure thing doc, and if it is OK with you, I’ll look up the internet to make sure you are on the money. I wouldn’t want to take chances, what with Saturn being in Sagittarius this month.” “Absolutely,” I chirped, and she took my written prescription willingly into her hand. I recorded some generous vitals, listened to her cardiac irregularity and background wheeze, and made notes for my partner who sees her next month. Hopefully when I, and Saturn, have moved on . . .Dr. Hector Baillie is a community general internist working in British Columbia. He writes about interesting cases and concepts that might stimulate discussion and change.

Compliance, adherence and nonsense

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