Map of life expectancy at birth from Global Education Project.

Friday, January 08, 2010

Toot toot

That was my own horn. The vox populi often asks, "Why can't we hear more about what the heck you're actually doing when you aren't writing this blog?"

This, among other things. We had this seemingly brilliant idea that if doctors got solid info about how often their patients with HIV missed taking their pills, the docs could talk to the patients about it more effectively and the people would end up taking more of their pills on time.

Sadly, no. What happened is that the doctors talked to the people about taking the pills more, but the people did not subsequently miss fewer doses. Epic fail. Fortunately, we had a lemonade machine. We audio recorded the visits and we had a way of coding them all so we could characterize what actually happened. It turns out the docs mostly just gave the people a hard time about it. Sometimes they threatened the people with death. You might think that ought to work but it doesn't work at all. Once in a while, they suggested specific strategies for remembering better or overcoming problems, but those were all the doctors' ideas -- they told the people what to do instead of inviting them to figure out the problem and come up with their own solutions.

That doesn't work -- these are adults, after all, and if they aren't taking the pills they probably have their own reasons. What we need is to have a non-judgmental discussion about that and see if the physician and patient can't find ways of getting their objectives better aligned and making pill taking actually work for the patient -- conceptually, as a goal, and as a practice.

The fact is, about half of the time, people don't take their pills the way the doctor thinks they should, if at all. A treatment might work great in clinical trials but it won't work in the real world if people don't follow it. Sometimes, especially as people get older, doctors just keep piling on the pills until a person has a dozen or more prescriptions. Very few people actually take all that stuff, almost nobody does it consistently. And they probably shouldn't, come to think of it, in many cases. But they might not be making the best choices about which ones to 86, if they can't have an honest discussion about it with the doc.

So a lot of what I do is related to that problem.

I'll get to the cost effectiveness analysis next, I promise.


C. Corax said...

But I take it you're still in the thick of research and can't tell us about ideas to fix the communication problem?

Cervantes said...

I can tell you about ideas. We want to teach physicians motivational interviewing techniques, such as are used by behavioral counselors. Of course, it's gonna be delivered in a 5 minute bites every few months instead of a 50 minute hour every week for six weeks, but we'll see . . .

C. Corax said...

That's kinda cool, but it seems to me that the initial presentation would have to be longer than 5 minutes.

I bet however it is presented to the good docs, you're going to have to make it sound as though it is fixing a problem with the patients, not with the doctors.

Cervantes said...

I didn't mean the physician training would be delivered in 5 minute bites, I meant the counseling they offer to patients would have to come in that form.

We present this as a skill physicians need to learn. Most of them respond to that favorably, they know this is a problem for them.

Early Symptoms of Lung Cancer said...

Hey my name is Alex Brown i want to tell you something that Health medicine is a science of healing.It encompasses a range of health are practices evolved to maintain and restore health by the prevention and treatment of illness