Monday, March 09, 2009

My Sister Says...

So when I give a medication recommendation I talk about why I think the medication would help, I talk about what it treats, what the side effects are and what the risks of taking the medication are. That's a lot of information to absorb all at once so I ask my patients if they have any questions about what I've said. Most of the time they decide to take medication, sometimes they don't. When they decide not to take it they've got good reasons, most of the time.

The only bad reason I've heard is: "I talked to my mother and she heard bad things about it, so I'm not going to take it."

Every inmate has a sister, a girlfriend, an aunt or a mother somewhere with some health care training. All of these family medical advisors know more about psychotropics and are more reliable sources of information than I am, apparently.

I try to be generous and remember that maybe there are idiosyncratic issues here, like maybe the patient did have a weird reaction to some medication that he doesn't remember but his mother does, or maybe there are multiple family members who all had the same problem with a certain medication so he might too.

But usually it's just a matter of trust. The inmate's LPN sister has taken care of him all of his life, has rescued him and given him shelter and sent him money when he needed it, so what she says about medication goes.

It reminds me of a story I heard when I was an intern. My attending went to visit his mother, who was in the hospital for elective surgery. He offered her some advice about her anesthesia, and she responded: "I'll talk to my doctor about that." Her doctor was an intern. My attending was the chairman of the anesthesia department at a major academic institution.

So I guess it goes both ways when it comes to being the family medical advisor. Are you the family medical advisor? Do you want to be? And if so, do they listen?