Episode 103: Are there side effects from telling patients about side effects?
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In episode 103, James and Mike discuss the whole concept of discussion of side effects with patients. They rarely disagree but commonly get confused and at the end they both develop all the side effects discussed, which goes completely against the available literature.
Show notes
1) Important elements of outpatient care
Comments
As a listener to the podcast
As a listener to the podcast (and a UBC pharmacy student), I am an advocate of the patient’s right to make a shared-informed decision regarding their treatment. Disclosing information about the risks of drug therapy is a vital component to this paradigm; however, it has been my experience that many clinicians do not believe serious side effects ought to be discussed at all, contending this will act to the detriment of adherence to necessary medications. In fact, this used to be common practice. In the 1500s, an ethical statute of the Royal College of Physicians stated, “Let no physician teach the people about medicines or even tell them the names of the medicines, particularly the more potent ones … For the people may be harmed by their improper use.” Violators were fined 40 shillings. In 1938, the FDA stated drug labels “should be written ‘only in such medical terms as are not likely to be understood by the ordinary individual.’” (Clin Pharmacol Ther 2009;85:335-9) The fact that this ideology persists today, despite evidence that this is incongruous with patients’ values (Arch Intern Med 2001;161:706-13), demonstrates we still have a ways to go in the evolution of the way drug safety information is communicated.
Korey
I have often wondered whether
I have often wondered whether you "cause" side effects by telling patients about it. I certainly feel (and this is a study with an n of 1) that I get more patients coming back and telling me about side effects when I have warned them about it beforehand. But I wonder if it just means that I give then the license to come back and tell me about it rather that sit at home and either not making the connection to the medication or making the connection and simply stopping it.
I also find that the patients that I have informed of possible side effects are not so easily spooked by scare stories in the popular press ( "statins make you muscles rot" and "Betablockers make you impotent and give you diabetes"). This is a big bonus here in the UK where large parts of the popular press have made it their mission of dividing all inanimate objects into the ones that either cure or give you heart disease and cancer.
Solid podcast. Continuing to
Solid podcast. Continuing to debunk dogma. I think the hard part, like Mike discusses, is documenting the side-effect discussion in detail. i.e. cough and angioedema for ace-i rather than just risks and benefits of the medicine discussed. Although, typing it right there seemed quick, so maybe that's not a great example. How about HRT? That would be lengthy.
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