Accept Your Limitations
Although doctors can help patients navigate the system and complete paperwork on their behalf, they can't fix the underlying problem.
"This isn't something that the individual doctor can solve in a one-on-one clinical encounter," says Dr Seth Berkowitz, an internist at Massachusetts General Hospital. Even if physicians could personally pay for each patient's medications, those patients would still struggle, he points out.
In a paper published in the April edition of the American Journal of Medicine, Dr Berkowitz analyzed nearly 10,000 chronically ill participants' responses to the National Health Interview Survey. Whereas nearly one quarter (23.4%) of the respondents reported underusing medication for cost reasons, another 11% reported both food insecurity and cost-related underuse of medication.
"These problems don't often exist in a vacuum," he says. A patient who can't afford her medications may not be able to afford food or have a home where she can rest and recuperate. "Simply addressing one part of the problem puts you in a whack-a-mole situation."
What's more, physicians must recognize that economic realities often force patients to make less than optimal choices. Dr Filer recently treated a patient who qualified for one-time assistance through his church but refused to squander the aid, which would have allowed him to fill a 30-day prescription, on a 5-day course of antibiotics.
Dr Berkowitz believe the movement toward accountable care organizations and patient-centered medical homes may help clinicians address some of these underlying issues by creating care teams that include care coordinators, social workers, and pharmacists. Such teams will provide more complete cost information up front and better follow-up with patients.
Until then, physicians, pharmacists, and most especially patients are left to cobble together solutions as best they can. That can take an emotional toll.
"I'm empathetic, but I'm also solution-driven. There are times I have awakened at 3 AM and thought, 'I wonder if so-and-so can help on this one.' It does stick in your head when someone can't afford their medication," says Dr Filer.
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Cite this: Shelly Reese. Patients Not Taking Their Drugs? Ways You Can Change That - Medscape - Jan 21, 2015.