Talking to Patients About Medication Use: How Your Peers Do It

To help you enhance your practice and increase your bottom line, we ask practicing doctors of chiropractic, like you, for ideas and solutions that have been tested in real-world environments. In this issue, we asked: "How do you assess and then deal with patients who are likely taking unnecessary prescription and over-the-counter drugs?" Based on your responses, there are some common philosophies regarding patient drug use.

The improper or unnecessary use of prescription and over-the-counter medication is a growing problem in the United States. According to a report published by the World Health Organization (WHO) in 2010, more than 50 percent of all medicines are prescribed, dispensed or sold inappropriately and half of all patients fail to take medicines correctly. This incorrect use may take the form of overuse, under use and misuse of prescription and over-the-counter medications. The WHO also believes that a combination of health care provider education and supervision, consumer education and an adequate medicines supply is effective in improving the use of medicines, while any of these interventions alone has a limited impact. Inappropriate self medication is on the rise and has a potentially high financial effect as well. According to the WHO report, between 10 and 40 percent of national health budgets are spent on medicine.

There are can be severe consequences to the incorrect or unnecessary use of medications and chiropractors often deal with some of the them when attempting to educate their patients about potential side effects and alternative treatment options. There is a growing concern over antimicrobial resistance. An overuse of antibiotics increases resistance and the number of medicines that are no longer effective against infectious disease. Chiropractors often deal with contra indications and harmful side effects when attempting to understand a patient's health and medical history. Adverse drug reactions have been estimated to cost millions of dollars each year, according to the WHO study. Patients can also waste money in over-the-counter medicine purchases. The WHO study estimates that billions of public and personal funds are wasted each year in unnecessary drug purchases.

According to most responses, unnecessary drug use (both prescription and over-the-counter) is not uncommon and communication with both the patient and their primary care physician was the key in dealing with this issue.

Scope of Practice Question

Several chiropractors urge caution when talking to patients about their prescription drug use. "The DC should not comment on the patient's taking of prescription drugs, whether necessary or unnecessary. Anytime a DC thinks that drug is incorrect for a patient, he/she should refer the patient back to his primary care physician for their expertise on the drugs," said Dr. Pete Fernandez. "If the DC tells the patient not to take the drugs, take less of the drugs or that the drugs are unnecessary, they are practicing outside of their scope of practice and probably guilty of malpractice....and definitely illegally interfering with the doctor-patient relationship of the MD and their patient."

However, Dr. Fernandez believes a different conversation can occur when over-the-counter drugs are the issue. "If the patient is taking over-the-counter drugs not prescribed by their MD, I would recommend the patient discontinue the use of these over-the-counter medications until they make an appointment with their primary care physician regarding these drugs. I would make a big point of the interaction between drugs and the many contra indications of taking conflicting medications or taking too much of the same type of drug (i.e. Indocin prescribed by an MD and aspirin/ibuprofen that the patient purchases over-the-counter)," said Dr. Fernandez.

Dr. Forest Mapes of Lyons, Ill. says, "if the drug is a non-prescription type, the answer is simple. The state of Illinois allows me to discontinue the drug. If it is a prescription drug, by law I am not allowed to interfere with it. However, I am able to make statements such as, 'If it were me, I would not take it.'"

Simple Patient Conversations

For many chiropractors, it just takes having a simple and honest conversation with your patients to help them understand what they are doing in taking these unnecessary drugs and what your philosophy is in approaching their treatment. Dr. Stephen Oetzel from Wilmington, Ohio, believes that "almost all prescription and OTCs are unnecessary, so I frequently remind patients that drugs do not nurture the body to heal, although if used temporarily they may save a life on an emergency basis. I have many patients who have taken themselves or their children off drugs while becoming healthy."