* * Anonymous Doc

Thursday, December 16, 2010

"Have you been taking your pills?"




"This is the eighth time in the past year that you've been admitted to the hospital for the same reason. When you don't take your pills, your blood sugar goes through the roof, and you end up back here. You need to take your pills."

"I was taking them, but then I was feeling better, so I stopped."

"Yes, that is the problem. The pills are what make you feel better. So you can't stop taking them when you feel better."

"But I felt better, so I didn't think I needed them anymore."

"You will always need them. Don't you see that this is what keeps happening when you stop taking the pills? You keep repeating the same thing."

"I thought this time would be different. I thought maybe I didn't need the pills anymore."

"You need the pills."

"But I was feeling better."

"Because of the pills."

"But how am I supposed to know when it's because of the pills?"

"It's always because of the pills. Can you promise me you will take your pills?"

"I promise."

"And you won't stop when you're feeling better?"

"But what if I'm really better?"

"You're not going to be better."

"Why not?"

"Please just take the pills."

I don't understand how so many of my patients exist in the world. How they function on a day to day basis. How they manage to stay alive. What happened to survival of the fittest? I don't even know how most of my patients cross the street without getting hit by a car. Or find their keys. Or refrigerate their milk. Or dress themselves. Or get to the hospital at all.


  1. I think survival of the fittest stopped being applicable to humans with all the improvements in medecine in the 20th century. Dumb people are here for the long haul.

  2. Get a diabetes expert in there, explain the disease. Don't just say "take the pills for the rest of your life" that doesn't work even with smart people!
    If they don't understand their disease, they can't be compliant!

  3. You said, "Just take the pills" instead of answering the patient's question? It's obvious that he doesn't understand what's happened to him. I agree with Anon 12:59. Get someone to teach him about his disease and how to manage it.

  4. I understand that it must be frustrating dealing with noncompliant patients, especially since you have 1000 things to do after hours and hours of work. And I understand that there is only so much one person (or doctor) can do to convince a patient to follow recommendations.

    That said, try to understand where they are coming from. Perhaps they are not accepting that they will be sick forever. Perhaps they do not understand the disease.

    Have you tried using a less paternalistic model in interacting with your patients?

    [By the way, I love your blog. I appreciate you sharing your experiences. -MS1 who is not yet jaded or aware of the true magnitude of demands placed on physicians]

  5. I doubt this is a verbatim conversation.

  6. Hahaha.

    Reminds me of when I was pregnant. I took B6 daily and 1/2 a Unisom every couple of days and felt so good I thought I was cured of morning sickness.

    The really sad part, I thought I was cured more than once.

    And I would stop the pills and puke.

    Because the last time, I guess, didn't teach me the error of my ways.

    I'm a pretty touchy patient and the convo as blogged didn't bother me at all.


  7. This patient probably needed psychotherapy, and not just an admonition to take her pills. Denial in diabetes, particularly Type 2, is very common -- maybe it went away while I wasn't looking!

    Type 2 diabetes is such a NUISANCE disease -- people can run high blood sugars and not really feel ill. Tight control takes a lot of attention, frequent testing and diet control and exercise. Many people are just not willing to do that. Denial is easier. Until they are in serious trouble, when they come to see you.

    The psychologist really needs to be a team member for good diabetes control.

  8. Survival of the fittest only runs its course when no one intervenes.....

    ...clearly, this one would not survive without the intervention....

    I am a recently diagnosed diabetic with a not so run of the mill case. Fortunately, I'm on top of it, educate myself, test, exercise, eat properly etc. But it is a very complex disease and everyone's body reacts slightly differently. I recently shared with at T1 friend that I did not know how people with less native intelligence managed with this disease....

  9. Oh god, this is such a problem wherever pills are involved. You get people with schizophrenia, or like my friend, bipolar disorder, and they're feeling better so they go off their pills and stop therapy and then wonder why they're acting psychotic again.

  10. Well after I ate the food I stopped being hungry, so I figured I wouldn't need food again and gave it all away. But then later I got hungry again, so I went to the ER. They have those yummy jello cups sometimes if you pass out in front of them.

  11. Why isn't "Stop eating the sugar" an option. If he were eating a steak, with a salad with ranch, and some brocolli with cheese, his blood sugar *wouldn't* go through the roof. And he wouldn't need the pills.

    I don't understand the doctor's take of "Everytime I eat carb foods, my blood sugar goes through the roof, and it makes me sick." The response? "Just take the pills." Why not "I told the doctor that it hurts when I do this. The doctor told me not to do that..."

    There is a pill for everything. Is there a pill doctors can take that will perhaps keep them from answering so many symptoms with pills?