I recently asked, “Who’s to blame?” for patients not taking their medications and cited a couple of papers describing the poor state of medication adherence. I concluded nonadherence was a huge problem, and doctors failing to educate their patients was not a major cause. To support my contention that physicians are not the reason why patients do not take their medications as ordered I submit the following new information. A 
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 54-year-old man is evaluated for elevated blood pressure noted recently at a local health fair. He has no other medical history and takes no medications. On this visit and on two subsequent nurse visits, the patient's blood pressure measurements are less than 140/90 mm Hg. BMI is ...

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STAT_Logo I’m a physician, a husband and dad, a guy who tries to live by the golden rule. But sometimes I’m an escort into sadness and despair, plunging families into the darkest emotional depths with the news I must give.

One particular case from years prior stands out. Mary (whose name and identifying details have ...

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For the last several weeks, I have been working as a medical volunteer on a remote island off the coast of Fiji called Batiki. Home to 234 natives, Batiki has no running water, and no electricity (other than solar generated power). The inhabitants are subsistence fishermen and farmers. They are filled with joy and a real sense of community. While on the island, I found extremely high rates of high ...

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More than anything, Willie needed a place to pee. Elaine needed help walking. Willie is homeless; Elaine is affluent.  They both needed someone to listen to them and help them find solutions to their most pressing everyday challenges.  That’s called “co-production of care.” When Willie found out he had congestive heart failure, his doctor put him on beta blockers with diuretics. The medications made Willie feel better, but there was one problem:  Because of ...

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I know, I know, I spend way too much time ranting about work in the emergency department. But after some recent shifts, my box of rants is full once more. And what I want to point out is the enormous struggle of the mid-sized emergency departments in America today. I know this is a problem; I work in them, and I know and talk with people who work in them. It’s ...

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The other day, rather than being at the office, I was sitting in the waiting room of our favorite gastroenterologist’s endoscopy suite. I had dutifully accompanied my wife, who was getting her colonoscopy. My cell phone buzzed. It was my nurse calling from the office. I had seen a patient late the previous day who was complaining of right leg pain. I had ordered a D-dimer, hoping the test would be ...

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In this current era of health care, patients are increasingly being labeled as “customers” to provide a landscape suggestive of the need to provide customer satisfaction. Many health care providers grow increasingly frustrated with that terminology. It demeans the relationship that is fostered in the patient-physician encounter; belittling it to a transaction that occurs as the exchange of goods for an expected outcome. Perhaps a more appropriate corollary to the ...

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I missed a drug interaction warning the other day when I prescribed a sulfa antibiotic to Barton, a COPD patient who is also taking dofetilide, an uncommon antiarrhythmic. The pharmacy called me to question the prescription, and I quickly changed it to a cephalosporin. The big red warning had popped up on my computer screen, but I x-ed it away with my right thumb on the trackball without reading the warning. Quite ...

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In Houston, all of my colleague's offices are closed, and there is limited access to the Texas Medical Center due to Hurricane Harvey. As a virtual medical doctor, there was only one thought on my mind this entire weekend, “How can I help?” As a Floridian, I have certainly faced my share of natural disasters beginning with Hurricane Andrew, a category 5 hurricane in 1992. Living through Hurricane Andrew gave me ...

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