"Your numbers haven't gotten any better since your last visit. Have you been taking the pills I prescribed?"
"Which pills?"
"The ________."
He pulls out a pill bottle.
"You mean these?"
"No, I mean _________. These are for something else."
"Oh. Sorry."
"The ones I prescribed for you-- have you been taking them?"
"I don't know."
"Why not?"
"I don't know which ones they are."
"They're __________. The ones I prescribed you last time."
"I don't know what they look like."
"They say ___________ on the bottle."
"I didn't tell you this last time, doc. But I don't know how to read."
"Oh."
"Yeah, so I have no idea which pills I've been taking."
"That's a problem. And thank you for telling me-- I wish you'd told me last time-- because now at least we can try to figure out a way for you to know which pills you're taking and when to take them. I can also get social work involved if you want to see if there are some reading programs you can get involved in..."
"Oh, it's too late for that."
"No, no, don't say that. Let me get social work involved. But in the meantime, let me write out the prescriptions, and I want you to go to the pharmacy, fill them, and then come back here. I'll find a gap between patients and, I don't know, we'll draw some pictures on the bottles, or something. I want you to take the pills you need to take, and I want you to know you're taking them correctly."
"What do you mean taking them correctly? Don't I just swallow them?"
"I mean some you take once a day, some twice, some with food--"
"I usually just take one of everything in the morning. And then usually I throw up."
"What? Why do you throw up?"
"I don't know! That's one of the things I wanted to ask you about."
"Okay, social work, GI consult, pills-- but first let me actually examine you, okay?"
...and my other patients wonder why I'm running an hour late...
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EXACTLY!!!! Cut the late doc some slack, people!
ReplyDeleteMaybe he pukes just because he's taking so many pills together on an empty stomach? Happens to a decent # of folks.
ReplyDelete~A.W.
We had a reading not too long ago about an illiterate patient; 64 y.o. with "history of noncompliance." It took months for someone to finally realize he was illiterate. Obviously it's becoming more and more rare, but it's still something like 12 percent of U.S. adults can't understand written prose. The numbers get more depressing for those over 65. It's tough because these patients don't get the care they need, and they tend to gravitate toward emergency rooms because someone else asks all the questions. Sad stuff...
ReplyDelete-C.G.