It does not have to be so dramatic. I mall walk for an hour five days a week with a 58-year-old black man. His only medication is a minimal dose of blood pressure medication. He leads a very health lifestyle and is very careful with his diet. No other health problems.

His doctor is fixated with him taking a statin. The last couple of years have become very difficult as the doctor has him on three-month office visits where the same exchange happens:

Doctor: Are you ready to take a statin?

Friend: No.

Doctor: Come back in three months and we will discuss this again.

Doctor leaves the exam room without saying another word. The last visit ended with the doctor proclaiming he would prove my friend needed a statin. The results were normal, per the doctor’s written letter, with a LDL of 122 and a HDL of 55. He will return in three months for a complete physical and this whole routine will start all over again.

The fixation of black male plus BP med equals statin overrides test results or patient’s desire. The result of this is my friend is loosing confidence in his doctor and is questioning the financial aspect of this relationship.

Guidelines create a great many unintended consequences.

Steve Lucas

JaneMarieMD

Thank you for your comment. The statin becomes secondary to several other issues.

Patient desire. My friend wishes to minimize the number of medications he takes due to a history of bad reactions.

Communications. At no time has the doctor discussed risk factors. The doctor’s only statement is he wants my friend to take this medication.

Economics. There is a cost in my friend making these repeated trips. Travel time to and from the doctor’s office along with wait time add up. My friend is also questioning the profit motive in having him repeatedly return for a two-minute conversation.

Extension, for lack of a better word. Is it the doctor’s intent that my friend accepts future prescriptions without question? This directly applies to DB’s comments concerning multiple prescriptions being given to one patient. Another friend is a pharmacist and he rants about this issue all the time. He sees people with eight or ten very potent drugs and calls the doctor’s office only to be told by the nurse: “This is the doctor’s orders.”

The unintended consequences are my friend has lost confidence in his doctor. He now feels compelled to question every decision and this will only make it more difficult for him to deal honestly with the doctor in the future. He is also aware that this doctor’s statin of choice contains an intestinal fat blocker, which has the nasty side effect of sending one to the toilet soon after eating.

My friend does not change doctors due to the medical culture in our community. He does not feel he will receive any better service from another doctor. A doctor friend was quite upset one evening when describing how new doctors in the community were causing major changes in their practice. The new doctors treated their patients with courtesy.

Steve Lucas

I have a friend that has M.S. he has had it for 23 years. He is on over 17 different medications. He has developed a bowel seapage, which is chronic. Could this be because of the drugs, or is this common with multiple sclerosis.