Doctor’s advice

Take two pills and call me in the morning. Simple enough advice. But many of us aren’t heeding doctors’ orders, in both small ways and big ones.

“You look and say, ‘Well, is this reasonable? Can I follow this?’ ” says Mary Wissink, a 49-year-old Spokane resident. “If it isn’t going to fit into your lifestyle or into your plan, you’re not going to follow it.”

Wissink, a paralegal, has been advised by her doctor to get plenty of rest to help her back pain. But that’s not often possible, she says.

“It is such a fast-paced world,” she says. “We can’t just take six weeks to recuperate.”

Two recent studies, one involving cancer survivors, make the point that we’re not always doing what the doctor recommends.

In one study, University of Massachusetts researchers found that breast cancer survivors often neglected getting mammograms, even though they’re more likely to have a new tumor develop than women who have never had cancer.

And another study, out late last month, found that patients stop taking their medications too early, even for serious diseases such as heart disease or diabetes. Just a month after leaving the hospital, one-in-eight heart attack patients stopped taking their pills, the study found.

It can be frustrating for doctors, says Dr. Alyssa Shaw, a family practice physician at Family Health Associates in Coeur d’Alene.

“I can talk to a patient about all the risk factors they have for disease,” Shaw says. “Their diabetes is out-of-control. Their cholesterol is high. And they continue to come back and each time I don’t see improvement. My whole goal is to get them better.”

But, she adds, “It’s equally frustrating to the patient because, for the most part, they’re trying. It’s just hard to change habits.”

Dawn Johnson, a 45-year-old Spokane woman, was diagnosed with Crohn’s disease, a chronic digestive disorder, in 1984. She takes all of her medications, she says, but admits having trouble following some of the lifestyle-change advice.

“While there is a large part of me that truly wants to follow these directions, the lazy part of me takes over and I usually end up exercising for about three or four weeks, at which point I frantically search for the fastest way back to my couch,” Johnson said via e-mail.

Robert Gordon has been a physical therapist for about 30 years. Most of his clients, he says, are motivated to follow through with his instructions.

“The majority of people are pretty compliant,” says Gordon, who works at the Center for Physical and Sports Therapy in Spokane. “There’s really no reason to lie to me because I work for them.”

The key, say Gordon and other practitioners, is making sure patients understand what to do when they go home.

“Give them some instruction, some background,” he says. “If you can review a skeleton with them, or some good diagrams in a book, that goes a long way. People understand what’s going on with their shoulder or knee or ankle a lot better. It makes it a lot more meaningful.”

Shaw says she can tell by a patient’s expression and questions whether he or she will follow her suggestions. And if it seems like they’re not going to comply, she negotiates.

“If they disagree, I look for a middle ground,” Shaw says. “Otherwise, I don’t think they’re going to follow up.”

She impresses upon them, for example, the importance of finishing all of their prescribed antibiotics. Taking a partial course of antibiotics can cause drug-resistant strains of bacteria to grow.

“We try to avoid antibiotics if they’re not necessary,” she says. “They understand if it is necessary, and if they don’t complete the course, they’re going to develop resistance and more trouble down the road.”

If a patient balks at taking several doses of a drug per day, Shaw says she tries to find another medication requiring fewer doses.

If you don’t understand the doctor’s orders, or even if you don’t plan on following them once you get home, it’s important to fess up. Not doing so could put your health in jeopardy.

“The most important thing is to be honest with your provider,” she says. “If they suggest a medication or a treatment that you have doubts about or hesitations, tell them upfront. To go home with something you’re not going to do isn’t helpful to you.”

Not infrequently, she says, the negotiation – particularly when it involves diet and exercise discussions – reaches an impasse.

“Sometimes, we do hit a wall and there’s no further medical intervention we can do,” she says. “The patient doesn’t feel they can change their behavior or habits. We let the patient know we’ve done all we can unless they’re willing to change.”