Everyone deserves the answers to five questions about their prescriptions, especially as they age. And if physicians and families can ask and honor the answers, care will be kinder, more respectful, more fulfilling, more transparent–and what people really want.
Understanding the goals of care, which my colleagues and I have teach in clinical medical ethics, allows everyone to understand and appreciate the the patient’s answers. The goal of care for many people is not survival or longevity but life quality and well-being.
Well being means a life that contains more of the activities and people we love, and personal priorities. And less of the things we don’t–often medical visits, surgical procedures, unwanted examinations. Atul Gawande has written eloquently about well-being in his book “Being Mortal“, and I’m proud he is making these ideas part of a public discussion.
My 5 questions are:
- What does this medicine do that will help me?
- How long do I need to take it and why?
- How does it interact with my other meds?
- What sort of blood testing or monitoring does taking it mean for me?
- Is there something I can eat or drink, or an activity I can do or change instead of taking it?
(I published an abbreviated list of these in The New York Times earlier, and Zeke Emanuel suggests 4 too, but the subject really deserves more attention than a single comment or Op-Ed can give).
Prescribing clinicians need to ask themselves two questions:
- Can I explain how this medication will improve a patient’s wellbeing or quality of life?
- Is the medicine likely to prevent premature death?
Ideally, these questions are asked with the patient’s significant others in the room, with the patient’s permission. Although family and patients don’t always have the same goals of care, most families are well-intended, and are often worried about the patient’s quality of life and ability to manage. I sometimes go to important appointments with my own patients, and with close friends and family.
Doctors want to answer all these questions, but they take time, and often have to be asked and answered more than once. Nearly all physicians are pressured to see more patients. Seeing each for a few minutes is more cost-effective than spending open-ended time with just a few, on subjects little taught and less billable. Economic issues often masquerade as ethical ones in clinical care, but neither are often discussed.
Because lifestyle measures–eating, drinking. sleeping and exercising well; being out in nature; mitigating chronic stress–are actually the best medicine, I think we will see not just a shift away from processed food and synthetic chemical additives, but towards more natural solutions as medicine: including more local, organic food; better work-life balance; uses of integrative therapies–already dramatically popular–such as yoga, meditation, chiropractic, herbal supplements, and green care.
When you really need a prescription drug, you should be able to get it. Pharma is listening to the outrage about medication cost; Pfizer recently doubled free availability to 40 of its prescriptions. But that’s the cart before the horse.
What people really need are the answers to my 5 questions about each drug they’re prescribed. Print this out and try asking in your next medical office visit. Write down the answers, and go home and think about them. Then decide.