What's the difference between a patient and a healthcare professional?

Is it education? Experience? Intelligence? Sometimes it's any combination of these factors, and sometimes it isn't. Sometimes the patient is a healthcare professional. Doctors get sick sometimes, too.

So when a pharmacist counsels a patient, it's important that you understand who you're talking to and how much they want or need to know. Of course, this is something that's taught in every pharmacy school in the country, and it seems pretty intuitive. You don't want to explain pharmacology to the 7-year old child, or tell a critical care nurse that "this white pill will make you feel better."

One place it does sometimes get a little complicated is the situation my preceptors are currently in. I'm in a drug information rotation, working for a company that produces, among other things, drug interaction databases for pharmacies and patient education handouts (obviously, for patients). The problem is that these two databases don't always coincide. The department creating the database for pharmacies/pharmacists tends to be a little more selective about which drug interactions and which side effects are included. They only include things that are likely to cause problems and that are decently well documented in the literature. The patient education handouts, on the other hand, include anything and everything. Everything listed in the package insert, every theoretical interaction and side effect, are all listed with warnings in strong language.

The retail pharmacies my company sells these products to are not happy about that. They're concerned that a patient will see these warnings and be angry that no one warned him or her about it. They're worried that the patient might just stop taking the medication on their own. It's a valid concern, I think; it happens more than it should.

The issue hasn't been resolved, and I'm not sure how it will be. But it brings up an important question. How much do you tell patients about their medications? There's a fine line between keeping patients informed and scaring them away. There are a lot of drugs that have extremely rare, but potentially serious, side effects. You can die from an allergic reaction to an antibiotic. Tylenol, even in low doses, can give you liver failure, and ibuprofen can in some cases give you renal failure. It's important that patients be aware that you have to be careful when taking drugs. But it's also important for them to understand why the drug is necessary.

Does that mean we shouldn't use these drugs? In general, no. For drugs that are currently on the market, we've decided that the benefits outweigh the potential risks by a great enough margin. But it's still scary to think that you might be the one patient in a million who gets a blood clot from birth control.

I think the best way to explain it is through risks and benefits. Yes, there is a risk for every drug you might take, and that's why it's better to be on fewer drugs. But in the vast majority of cases, you are more likely to get sick from the disease than from the drug.

(Of course, this comes with the caveat that the risks and benefits need to be clarified in clinical trials. But that's what phase III drug trials are for.)

It's not as obvious as it sounds, when you're the patient reading that package insert. I had a friend call me recently, one who's in the medical field, because she wasn't sure if she should take the course of antibiotic she had been prescribed. She was concerned about the serious (and potentially real) side effects she might get from the drug. I think it put things in perspective a little more when I pointed out that the risk of getting endocarditis (and having to be on IV antibiotics for six weeks at least) was greater than the risk of getting this side effect. But if you aren't used to thinking about things in terms of risk, benefit, and likelihood, it's easy to get caught up in what could happen.

Today's doctors are many things, but teaching or teacher aren't words generally associated with them (except perhaps in academic medicine). The word "doctor" invokes a particular set of images in popular culture - white coat, scrubs, stethoscopes, always doing something - but the word may not so often invoke the more unglamorous image of patient education. It's my belief that every med student and resident chooses to become their own unique "kind" of doctor, their own way of interpreting the art and the science. Thus it's my belief, and my choice, that doctors should be teachers.

During my one-year foray into public health, one of the greatest experiences of my life was teaching several discussion sections of the undergrad intro to genetics course, alongside other grad student instructors (GSIs, also called teacher's assistants or TAs elsewhere) and the professors of the course. Standing by the blackboard in front of a room of 20-30 undergrad students kept me on my toes (figuratively and literally) and oddly energized. Here I was, imparting knowledge onto students, clarifying concepts and facts, elucidating materials from lecture more in depth, intently watching for the wheels in their minds to turn. Everything I said mattered, mistakes and incorrect knowledge could backlash with great fury, so I had to be sure and confident of what I said. At the end of the day, I hoped that I had sparked that interest in someone to take the knowledge they learned from me and do something great with it.

In my opinion, medicine (particularly primary care) isn't so different. Doctors impart health knowledge onto patients, clarify misconceptions on health issues, answer questions, recommend medication and treatment plans, and hope the patients comply and carry through because they understand and trust their doctors. At the end of a visit, I would hope a patient would take the knowledge he/she learned and do something great with it - keep themselves healthy, improve their health, or even educate others. I feel many students go into medicine because it's a decisive field - you're sure (or at least act sure) of the medicine or treatment you give your patients. Truth be told, you'll never know if your patients actually take their medication or follow through with your recommendations after they leave your sight. And so proper education, communication, and trust are vital.

Already I've had a couple experiences in med school that can attest to the role of doctors as teachers. About a month ago I went to a nearby high school with another M1 med student. We were to give a presentation on obesity and diabetes to a 10th grade health class. My love of teaching instantly rushed back. At the end of the presentation there was still 5-7 minutes left before the end of the class, so we opened it up for the students to ask us any question. One student asked me, "What do you want to do after med school?" Which I initially thought was an odd question, so I answered, "Umm . . . become a doctor." He continued with something like, "Do you want to keep doing stuff like this? Coming into classrooms and teaching about health?"

That struck me. Of course I would love to go to a high school a few times a year into a health class and give a talk on some health topic. I would love that kind of community interaction as a practicing physician. I then realized how uncommon it must be for doctors to take a day or half-day off work and go into the community and do just what I did as a med student. I couldn't recall in all my years of primary education of seeing a doctor come in and give us students a health presentation. There's definitely a role, and sometimes perhaps a need, for doctors to go into the community, talk to a group of people, and educate them on some common health issue. This is certainly one role of doctors within public health.

This isn't to discount the important and integral role of the one-on-one patient-physician relationship. A couple weeks ago while volunteering as a "patient educator" at a free clinic, I saw a late middle-aged gentleman who wanted to discuss smoking cessation and depression. It was a wonderful opportunity for me to interact with patients outside of the rigid "medical interview, physical exam, diagnosis, and treatment" template. We talked rather freely as I asked him questions about what he's done, his personal and social environment, and how we can "tailor" a way to help him with these two issues that works with his life situation rather than against. I felt that to a certain degree, a more relaxed medium of communication between physicians and patients may yield better adherence to medical/health advice, as opposed to a more didactic approach commonly found in medicine. Then again, I've certainly no research to support this.

Lastly, a doctor is a life-long student and teacher. The field of medicine changes so rapidly it's mind-spinning. It can take a lot of work just to keep up and learn the newest updates, and at the same time relay this information to colleagues and patients. But it's a challenge we signed up for the moment we set foot in med school. As future doctors, I believe it's our duty to educate our patients so they may make the best and healthiest decisions for themselves.

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Money, dollars, bills - those green pieces of paper with numbers and faces on them, are what's on everyone's mind these days, especially in the healthcare field. With the so-called economic crisis, resources are scarce in the medical community. I've heard many stories concerning the use of the emergency room as a way for patients to get over-the-counter meds, but I have never experienced it myself until my clinical preceptorships at the ED (emergency department). Now I realize how hard it is to be non-judgemental.

Many times I would see patients come in for conditions such as a common cold and ask to be prescribed tylenol or motrin. They would wait many hours in the waiting room with a fever and a cough, and use up not only medical resources but also their own precious time. When doing social histories, I'd ask patients whether they smoke or use alcohol. Oftentimes the answer to both is yes. With a pack of cigarettes costing $4 and alcohol being on a range of prices, people can end up spending a lot on these two amenities many consider essential in life. Being a non-smoker myself, I sometimes find it hard to be non-judgemental, for patients would spend on cigarettes yet not for medication for their condition.

After many such encounters, I talked with one of my preceptors about the situation. He responded that I can't be judgmental; if I grew up in similar situations as the patients, then the patient might be the 2nd-year medical student and I could be the smoker and alcoholic. I realized the importance of education, and what "don't judge the book by its cover" truly meant. With the healthcare in great need of reform, more attention should be placed on implementing earlier education in schools. Instead of the majority of attention being focused on where funds should be allocated or how to better manage the ED, funding should be placed in sexual education, health courses, and lifestyle-related courses in middle and high schools.

I don't know if what I'm advising is doable or valid, but I feel like it would be a step in the right direction in solving the healthcare crisis we are facing. Although this is easier said than done, with more attention placed in this field, perhaps we can shift our attention to better, more feasbile, and smarter methods in solving the education crisis.