Garth A. Rattray | The frustration of patients’ non-adherence

SEVERAL MONTHS ago, I saw a group of workers, mostly young to middle-age men, whose jobs involve intense labour on construction projects.

In spite of their hardiness, I found that several of them had no idea that they were hypertensive and two were diabetic. None of them had any symptoms of their potentially serious and possibly deadly problem. Nothing gave them any inkling that their lives were in mortal danger.

As is my habit, I counselled them on their conditions and went to great pains to explain the seriousness of not getting them under control. I gave examples of what can and will happen if hypertension and diabetes are left to their own devices. I am often criticised for “taking too long with patients”, but I believe that doctors have a duty to educate patients about their medical conditions. With education comes understanding and the power to prevail.

The workers with uncontrolled hypertension and uncontrolled diabetes were given follow-up appointments, but not even one came back until he was forced to do so in order to complete a medical form for an upcoming contract. Only one filled his prescription, but he said that he “completed the course” and didn’t repeat the meds (although a repeat was clearly specified). So, we were right back where we started many months ago. “Thank God for that work contract …”, I thought to myself, “… it probably saved their lives”.

I never reprimand non-adherent patients, in fact, I never say anything to stress them out. However, I always find myself reflecting on the many patients who suffer and die just because they don’t like taking tablets, distrust what ‘drugs’ can do to their bodies or figure that they feel fine, so all must be well. What I find interesting is the fact that a patient will not take one or two tabs for (say) hypertension but, when a medical catastrophe occurs, he/she ends up taking eight or even more tablets every day, just to keep going.

NO SCIENTIFIC EVIDENCE

Patients regularly complain about the unnatural nature of man-made drugs (medications) and that they “must” be doing damage to internal organs. So, they sometimes opt for the multipurpose garlic, or some other natural substance that they hear about, in order to control everything from hypertension and high cholesterol to diabetes and infections. There is absolutely no scientific evidence that garlic reduces high blood pressure, but it remains the number-one choice among pharmaceutical opponents.

In my almost 40 years in the medical field, I have seen just about every complication of hypertension and diabetes. It is always extremely distressing and painful to watch patients suffer and needless demise (prematurely) all because they don’t adhere to the things that they need to do in order to improve their health. I especially recall a 30-something-year-old man of East Indian origin who always refused to take his diabetic meds. When he eventually needed insulin therapy, he refused even more. The last time that I saw him, his two sisters brought him to see me just so that he could say goodbye. He died two days later in hospital.

Although only very few medications MIGHT have side effects, the conditions that they treat ALWAYS have serious side effects. Hypertension can cause heart failure, fatal heart rhythms, heart attacks, aneurysms, stroke, kidney failure, amputation, blindness, erectile dysfunction and dementia. Diabetes can cause the above conditions plus serious or deadly infections and nerve damage. Globally, hypertension and diabetes are far deadlier than COVID-19; respectively, they kill 7.6 and 4.2 million people annually.

These are modifiable diseases; proper diet, exercise, adequate rest and (perhaps) medications will control them. But they can be very sneaky, so having regular check-ups, follow-up visits and meds (if needed) are life-saving. For doctors, the struggle is real.

Garth A. Rattray is a medical doctor with a family practice. Email feedback to columns@gleanerjm.com and garthrattray@gmail.com.