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Old 07-07-2009, 01:08 PM
 
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This is no different than having people pay more for their lifstyle that requires many of these medcaines really. For instances ;hethy people that drink too much and people that take illegal drugs be screened and kicked out. Will this solve the problems?Not likely. We now see people taking deadlier illegal ugs.
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Old 07-07-2009, 01:19 PM
Status: "happy again, no longer catless! t...." (set 6 days ago)
 
Location: Cushing OK
14,422 posts, read 16,686,996 times
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Quote:
Originally Posted by ChrisC View Post
In my view, if the doctor has prescribed a med and you are not taking it, you are in essence opting out of the system. Which is your right of course, but at that point, you should be a big boy and face the consequences of your actions. You either pay the money to correct the consequence out of your own pocket or you have no further treatment. Sounds harsh, but if you want to play that game, you need to stand by your choice's outcome. As I've argued in other posts, everyone should have the right to refuse medical treatment (in this case prescription medication), but if you do that, you've made your choice and you are on your own.
Twice I have stopped taking medications that were causing such bad side effects any "good" effect was nullified. One was listed by the FDA as having a warning to not give to those with cararacs or who had had cataracs. I took it ALL the way from before the formation to the second eye being effected. I looked it up on my own. Sorry if I don't trust that the doctor knows best because they do not educate themselves on drugs and their side effect and most of the time dismiss the side effects as not important. But isn't it up to the patient to decide what's important?

Another time, post the first occurence, I was given a perscription by a doctor who said it had only "minor" side effects but couldn't name any of them. I looked it up. It commonly caused a condition which already effects me, and would likely land me in the ER if I'd taken it. So I go to see him the next month and explain. Does he look it up? Does he listen? No. He is the god doctor and I am being bad. Next doctor discussed it with me and agreed with me.

Patients don't take medications for a lot of reasons and sometimes its because doctors choose to make decisions about what the patient should consider acceptable without consulting the patient. It is YOUR body and you should be able to choose what you will put inside it, or what 'side effects' work within your life. If you live upstairs and climb up and down stairs multiple times a day, something that makes you dizzy is a big question. If you find a drug destroys your memory and thought process but makes you calmer, what if the drug has destroyed the way you live too?

Doctors do not consider these things and label those who do "bad patients". We need to remember that while doctors have a lot of knowledge they cannot see inside their patients heads, and medicine must work with the whole life, not just something you can test in a lab. Nor do most doctors educate themselves properly about the whole range of effects a drug has. If I don't take my meds because they make me exist in a fog, I think I have a good case for making the choice. There are always degrees. But the heart of it is that if the patient is not comfortable with the drug the doctor should work WITH them, not dismiss or label. You and your doctor are parters in your health, not overlord and serf.
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Old 07-07-2009, 01:42 PM
 
Location: 125 Years Too Late...
10,341 posts, read 9,982,800 times
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Quote:
Originally Posted by nightbird47 View Post
Twice I have stopped taking medications that were causing such bad side effects any "good" effect was nullified. One was listed by the FDA as having a warning to not give to those with cararacs or who had had cataracs. I took it ALL the way from before the formation to the second eye being effected. I looked it up on my own. Sorry if I don't trust that the doctor knows best because they do not educate themselves on drugs and their side effect and most of the time dismiss the side effects as not important. But isn't it up to the patient to decide what's important?

Another time, post the first occurence, I was given a perscription by a doctor who said it had only "minor" side effects but couldn't name any of them. I looked it up. It commonly caused a condition which already effects me, and would likely land me in the ER if I'd taken it. So I go to see him the next month and explain. Does he look it up? Does he listen? No. He is the god doctor and I am being bad. Next doctor discussed it with me and agreed with me.

Patients don't take medications for a lot of reasons and sometimes its because doctors choose to make decisions about what the patient should consider acceptable without consulting the patient. It is YOUR body and you should be able to choose what you will put inside it, or what 'side effects' work within your life. If you live upstairs and climb up and down stairs multiple times a day, something that makes you dizzy is a big question. If you find a drug destroys your memory and thought process but makes you calmer, what if the drug has destroyed the way you live too?

Doctors do not consider these things and label those who do "bad patients". We need to remember that while doctors have a lot of knowledge they cannot see inside their patients heads, and medicine must work with the whole life, not just something you can test in a lab. Nor do most doctors educate themselves properly about the whole range of effects a drug has. If I don't take my meds because they make me exist in a fog, I think I have a good case for making the choice. There are always degrees. But the heart of it is that if the patient is not comfortable with the drug the doctor should work WITH them, not dismiss or label. You and your doctor are parters in your health, not overlord and serf.
I am not talking about a case wherein there is a mis-prescribed medication. That is an entirely different matter. I'm talking about someone who doesn't take it because he/she just 'doesn't want to' and is aware of the consequence. I had an aunt who did this habitually simply to 'get attention.' I think there are less costly ways to do so and the expense shouldn't be passed on to others.

As for medications that are creating more problems than they are helping, yes by all means don't take them and get some other opinions.
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Old 07-07-2009, 01:58 PM
 
2,838 posts, read 8,844,735 times
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Um, no.

Let's say I go into the doctor for bad headaches. The doc hands me a prescription for migraine medication. I come home, do some research on the medication, and think "nah, too many side effects, I'm not taking this." The insurance company should not pay for me to go back to the doctor and request alternate treatment?

Here's another one: Let's say I get thrush from breastfeeding. I see my doctor, who recommends Diflucan, taken daily for 14 days. I decide not to take the Diflucan, because of the possible damage to the liver and because I'm breastfeeding. I go home and treat the thrush with herbal remedies that my lactation consultant recommends. She also recommends a different, topical prescription, but the thrush goes away with just the herbal remedies. Two months later, the thrush returns, and I'd like the topical prescription. Should the insurance refuse to pay for that, because I "refused" to take Diflucan two months ago for the same problem?

Doctors can't just tell patients "take this," and expect that there will be 100% compliance 100% of the time. People can and should have input on their treatment plans, and the attitude should not be "my way or handle it on your own." There is almost always a second or third or fourth option when it comes to choosing medications.
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Old 07-07-2009, 02:03 PM
Status: "happy again, no longer catless! t...." (set 6 days ago)
 
Location: Cushing OK
14,422 posts, read 16,686,996 times
Reputation: 16430
Quote:
Originally Posted by ChrisC View Post
I am not talking about a case wherein there is a mis-prescribed medication. That is an entirely different matter. I'm talking about someone who doesn't take it because he/she just 'doesn't want to' and is aware of the consequence. I had an aunt who did this habitually simply to 'get attention.' I think there are less costly ways to do so and the expense shouldn't be passed on to others.

As for medications that are creating more problems than they are helping, yes by all means don't take them and get some other opinions.
I agree that choosing not to take your diabitic meds is just as bad as drinking a case of soda for a diabitic. The problem is how do you tell when it hits the paperwork?

I'm pretty sure the doctor who blew me off said I was noncompliant. It was quite obvious that he didn't much like that I looked up the paperwork on the drugs and dared second guess him. I had a valid reason, and even if it wasn't a common side effect it was my choice. Its not like there are not other drugs which do the same.

Its not so easy to get another oppinion in a clinic. I probably saw my doctor about an hour and a half a year there. And I should say doctors. I saw one twice but that was all. This is the reality of a state operated system.

So when does someone who is watching out for themselves get labeled as noncompliant so the insurence company assumes? Until we have the respect of the doctor for the patient and the patients choices so the doctor can work with them this is opening up a huge hole where those who do research for themselves can be stuffed.

In the case of a diabetic its easier but what if its something less clear? What if a med just doesn't make you feel right? No specifics, nothing you can point to, but when you don't you don't feel that way? Maybe you'd say you didn't want to. Maybe you've tried to complain and nobody listened.

Especially with this data base proposed where those notes in the doctors records will live forever we need to be very very very careful to not preserve the scribbled words of a doctor who is annoyed because he was questioned to label. (I oppose the data base for that very reason). If someone comes into the ER feeling sick and hasn't been taking meds, instead of the third degree, someone needs to talk to them and see why they don't want to, no recriminations or blame. You think threatening someone will do better?

We may have a lot of good technical medicine out there, but we need to add the part where the patients life matters too, and their wishes and overall quality of life. The old family doctor might not have has all the gizmos but he did know the patient and how they lived. That too is a very vital and necessary part of medicine. We need to treat the WHOLE person, not just a symptom or we really are not offering health care.
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Old 07-07-2009, 02:36 PM
 
Location: Portlandia "burbs"
10,236 posts, read 13,523,621 times
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Quote:
Originally Posted by 1phwalls View Post
Should insurance companies and hospitals have to cover people going back and forth to the the Dr and ER if the person is not taking their medications. I'm not refering to people who have to chose between paying for meds and food or rent or whatever. Just patients who refuse to take medications that are needed to treat their condition.

I am asking this because I work in a healthcare facility. One of our patients has been hospitalized since March for over 60 days on 6 different occasions. Every time he states he does not take his prescriptions, which is obvious when he goes in with his heart rate over 200.

So, if a prescription is filled and testing proves the medication is not in the persons system, should they be cared for?
I do have one question first: Is this person's visits covered by insurance? Or is he/she adding more strain to the healthcare system by needless, repeated unpaid-for visits?

There could be some factors involved here. I have to wonder why anyone would ignore meds that would keep their heart rate in control. Could there be some side-effects that makes this person decide to non-comply?

Think this person "likes" to check himself/herself in when necessary? I have a relative who seems to LOVE surgery! Don't know the reason but it's obviously a mental thing with him. Is it possible that this patient likes feeling "taken care" of?

Sticky stiuation.
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Old 07-07-2009, 03:02 PM
 
Location: Cleveland, OH
753 posts, read 2,165,053 times
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The patient in my OP is on medicaid. So everything is 100% paid for - by tax money.

He has given one reason that he will not take the BP meds, he has been told that BP meds cause you to be impotent.

Several options have been presented to help with impotence, if it did happen. Not interested.

And yes he does like going to the ER, cause then he gets pain meds. No he does not like being taken care of, he is very nasty to the staff and doesn't want them bothering him.

But in his case, not taking the meds due to this fear of being impotent is stupid, cause he aint gettin any in the hospital either!

But he is just one case that I have with similar noncompliance issues. He is not willing to discuss any other possibilities, so it boils down to not wanting to take any meds.
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Old 07-07-2009, 03:31 PM
 
2,838 posts, read 8,844,735 times
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Quote:
Originally Posted by 1phwalls View Post
The patient in my OP is on medicaid. So everything is 100% paid for - by tax money.

He has given one reason that he will not take the BP meds, he has been told that BP meds cause you to be impotent.

Several options have been presented to help with impotence, if it did happen. Not interested.

And yes he does like going to the ER, cause then he gets pain meds. No he does not like being taken care of, he is very nasty to the staff and doesn't want them bothering him.

But in his case, not taking the meds due to this fear of being impotent is stupid, cause he aint gettin any in the hospital either!

But he is just one case that I have with similar noncompliance issues. He is not willing to discuss any other possibilities, so it boils down to not wanting to take any meds.
Well, this sounds like a drug seeker... but let's take out the drug seeking behavior.

I personally would not jump at the chance to take a drug for one thing, then a drug to combat the side effects of the first drug... ESPECIALLY when high blood pressure may be lowered by lifestyle changes. So, what if the patient said "I'd rather not deal with the side effects of BP meds." Let's say he'd rather take six months to lose weight and increase his activity level while decreasing his salt level. Let's say those changes make a negligible difference. Would you then say that his insurance company should not cover follow up visits, because he didn't want to turn to your drugs first?

What about cancer patients? Maybe after five years of on and off chemo, radiation, etc, a patient is ready to call it quits. Should they be denied pain medication and hospice care because their doctor feels that they should do another round or two of chemo?

It's such a slippery slope, especially considering that it would be an impossible policy to enforce unless it was "zero tolerance" for not jumping when your doctor suggests it... do we really need to restrict general freedoms even more? Make it so that people are afraid to refuse medical treatment, even if their research tells them there are other, safer, and possibly more effective options?
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Old 07-07-2009, 03:45 PM
 
5,273 posts, read 11,910,304 times
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Quote:
Originally Posted by ChrisC View Post
I am not talking about a case wherein there is a mis-prescribed medication. That is an entirely different matter. I'm talking about someone who doesn't take it because he/she just 'doesn't want to' and is aware of the consequence. I had an aunt who did this habitually simply to 'get attention.' I think there are less costly ways to do so and the expense shouldn't be passed on to others.

As for medications that are creating more problems than they are helping, yes by all means don't take them and get some other opinions.
Under the circumstances you describe, I think a health carrier has a right to refuse to pay further health care costs. Needless to say, before that can happen a medical investigation would need to be done that can authoritatively state that the casuse of further hospitalization is the direct result of non compliance. Before locking a person out of health care provisions, I think "t's" need to be crossed and "i's" dotted.
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Old 07-07-2009, 04:26 PM
Status: "happy again, no longer catless! t...." (set 6 days ago)
 
Location: Cushing OK
14,422 posts, read 16,686,996 times
Reputation: 16430
Quote:
Originally Posted by beanandpumpkin View Post
Well, this sounds like a drug seeker... but let's take out the drug seeking behavior.

I personally would not jump at the chance to take a drug for one thing, then a drug to combat the side effects of the first drug... ESPECIALLY when high blood pressure may be lowered by lifestyle changes. So, what if the patient said "I'd rather not deal with the side effects of BP meds." Let's say he'd rather take six months to lose weight and increase his activity level while decreasing his salt level. Let's say those changes make a negligible difference. Would you then say that his insurance company should not cover follow up visits, because he didn't want to turn to your drugs first?

What about cancer patients? Maybe after five years of on and off chemo, radiation, etc, a patient is ready to call it quits. Should they be denied pain medication and hospice care because their doctor feels that they should do another round or two of chemo?

It's such a slippery slope, especially considering that it would be an impossible policy to enforce unless it was "zero tolerance" for not jumping when your doctor suggests it... do we really need to restrict general freedoms even more? Make it so that people are afraid to refuse medical treatment, even if their research tells them there are other, safer, and possibly more effective options?
We have the right to refuse treatment if we are adults. It should certainly follow that we have the right to refuse specific treatments as well. The problem with the way we do things is pop a pill. Lifestyle, stress reduction, therapy, diet, nutrition are all ways of doing things differently but the medical establishment does not want to recognize that. Yes, a pill is sometimes necessary. But maybe by losing some weight, getting active, resolving some personal problems that pill might be temporary or much less. But its so much easier to pop a pill.

Insurence companies would much rather a patient take a sedative than see a counseler. The sedative is cheaper and the counseler will cost much more. But for the patient the counseler will likely solve the reason the sedative is needed. We practice maintaince of illness rather than restoring health, and insurence companies sell sickness insurence.

This is especially prevanant in the mental health field. bipolar and cycling a lot? You get a higher dose. Maybe the reason is you have circumstancial reasons for moods to flip, and resolving those reasons would change everything. But pills are simpler. Feel like a zombie and cut them back and you can be called noncompliant.

Before the advent of the internet, researching drugs was a difficult thing. But now it isn't. Doctors do not have an exclusive club anymore. The do not like it when patients do their research. Most doctors dismiss the patients concerns. But we're bombarded by ads for drugs the drug companies really want us to tell our doctors to order. Why should we not follow up on the parts the drug companies don't want us to know?

I think all doctors should be responsible for full disclosure of meds before giving them to their patients. This includes side effects, unknown dangers and interactions. It certainly includes the common and normal effects of the drug. If the patient chooses not to take it the doctor should be required to find another way. If the OP's example doesn't want to take the meds then the doctor should deal look at other options rather than insisting on pills. Lets not judge his choice of taking a risk or not taking a risk since its HIS choice.
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