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Physicians, Patients, and Pills (Part I)

By on March 11, 2012

Pills don’t always work the way we think they do. Half a pill doesn’t always mean half the strength, and twice the medication can quadruple
dangerous side effects. Well-chosen medications soothe our pain, but a rowdy mix will use our body as a battleground. Trusting your doctor, and allowing your doctor to trust you, are absolutely essential elements of quality health care.

As prescription painkiller abuse has risen, the doctor-patient relationship has become more difficult. Doctors must now constantly worry that they are being misled. It’s important to remember that they’re doing this to make sure they’re serving you correctly. Here are five ways to protect the integrity of your prescription.

1.      Always follow prescription medication directions carefully. When it comes to medication management, there is no substitute for a medical degree. That’s why only your physician can write prescriptions. You should think of your doctor as your personal health expert, who took four years to earn their wings in medical school and then at least three years in residency to perfect their work under an expert’s watchful eye. If you have questions and suggestions, discuss them with your doctor before trying them out. Ask your personal expert, they will have your back.

2.     Don’t increase or decrease doses without talking with your doctor. Why risk ending up in the hospital, or worse, when a simple
heart-to-heart discussion with your doctor can give you an answer that keeps you safe? A sudden or unplanned change in medication can have bad side effects that you did not bargain for.  This is the very reason you see a doctor—he or she can use their expertise to design a medication
plan that will protect your health.

Openness, candor and direct communication are key ingredients for a mutually beneficial physician-patient relationship. Nowhere is this truer than in the risky and emotionally fraught field of pain management. When your pain is at its worst, remember that you should rely on your doctor. If the medication (e.g. pain pills) is not cutting it, tell your doctor.  Trusting your doctor will keep you safe, and calling him or her before changing plans will help them to trust you, as well. If you can’t discuss your medication and health openly with a doctor, then perhaps it is time to find a new keeper to entrust with your medical care.

3.     Don’t stop taking medication on your own. By now you’ve noticed a theme—if you want your medication to help and not harm, you have to follow your doctor’s instructions. Ending a treatment routine is as complex as starting a new one, so don’t quit your prescriptions cold turkey before their time.

Some medications need to be continued well after the symptoms have disappeared. Antibiotics are an obvious example—if you stop taking them before their time, your infection might bounce back with a brand new resistance to drugs. Other medications, such as antidepressants and prescription painkillers, often need to be gradually and expertly titrated downward before you wean yourself off of them entirely. Let your doctor escort you off of a course of medication rather than taking matters into your own hands.

4.     Don’t crush, chew or break pills. Let’s be real here. If your doctor wanted you to find new uses for the pill, she would have told you that in the office. Don’t mistake your adult medication for a children’s chewable vitamin. Many pills are ingenious drug delivery systems in disguise, covered in layers of coatings to ensure that medication is released slowly and in strategic locations in your digestive tract. Pills are meant to be swallowed whole, so pull out a glass of water and swallow.

5.     Be clear about the drug’s effects on driving and other daily tasks. There’s a reason that you need a photo ID to buy alcohol, but a doctor’s legally binding signature for strong painkillers. Prescription pain medications can affect our cognition just the same  as alcohol, and sometimes more.


Moshe Lewis MD, MPH, MBA is currently on the Volunteer Clinical Faculty of UCSF. Dr. Lewis also serves as the Chief Medical Officer for Blackwomenshealth.com and is a Medical Contributor for healthyblackmen.org.


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