I once saw a patient who had suffered a stroke after missing a couple doses of her blood thinner. She told me that she had forgotten to take her medication while on vacation but figured it was not a big deal. I shook my head in disbelief and asked her how much she knew about her apixaban prescription.

Not much, I came to find. She didn’t know that it is supposed to be taken twice a day, at specific times to avoid the risk of a blood clot. She didn’t know that NSAIDS could not be taken with apixaban. The list went on, and although I was not interested in making her feel bad, I was interested in how much counseling and education she had received when first prescribed this medication regimen.

 

The importance of patient communication

 

Unfortunately, we do not typically enough time to counsel our patients as effectively as we would like, and I truly believe this leads to poorer prognoses. 

We can call it noncompliance, we can blame the patient, but in reality, we are the ones with the knowledge and training. And while I believe patients should be proactive about their health and do their own research, we should be directing them to appropriate resources. 

There are so many things I wish patients knew about medicine and healthcare. Here are some examples of medical knowledge that seems very basic to us as physicians, but of which most patients aren’t aware.

 

The difference between ibuprofen and acetaminophen

 

The full dose of ibuprofen is 800 mg, or four 200-mg tabs, and the full dose of acetaminophen is 650 mg. I have lost count of how many people I encounter who take half the recommended dose and wonder why their menstrual cramps, knee pain, or headache have not subsided.

If a patient is able to take ibuprofen, they must take the full dose for it to have an effect. Alternating acetaminophen with ibuprofen potentiates each other, meaning that acetaminophen helps ibuprofen work better, and ibuprofen helps acetaminophen work better.

Acetaminophen works to reduce pain and fever, whereas ibuprofen works to reduce pain and inflammation. It is important patients do not take more than the daily limit of each, and other restrictions may apply based on medical history. 

 

Have a living will and update your code status

 

We are mortal, and regardless of our age, income, or health status, our life can end at any time, or we can come into the hospital unresponsive. The hospital staff needs to know who is making medical decisions for a patient, as well as their code status, regardless of age or health status. 

As a doctor, one of the hardest decisions to make is when a patient is coding and you don’t know their code status, to later find out they are a DNR case. 

 

I have done this, and it is devastating—not only for myself but for the patient and their loved ones.

You must have someone in your life who will make medical decisions for you, and you must designate this person after you have expressed your wishes to them. If you do not have this person, you can create a living will. I highly recommend carrying your code status and your living will in your wallet. 

Whether you want to be resuscitated is a personal decision, and I believe it is important for doctors to educate their patients on what DNR actually means. Codes are intense and in many ways traumatizing, and yes, they can save your life, but your morbidity may or may not decline. 

 

Be familiar with your medications

 

I wish all patients kept up to date on their medications—both prescription and over-the-counter—and the dosages. It's important that patients write them down, keep the list in their wallet, and update the list regularly. When a patient starts a new medication or ends one, they should bring the updated list to their doctor. This is a common cause for medical error, because there are so many interactions and side effects among medications.

 

Pain is difficult to treat

 

I have lost count of how many patients have acted out in anger toward me because I was not able to adequately treat their pain.

Our goal as physicians is to figure out the root cause so we can treat the underlying problem instead of prescribing medicine that just masks the pain. We don’t want our patients to be in pain, and we are trying our best to provide treatment, but this may take time, multiple visits, alternative regimens, consults with specialists, and some difficult conversations. 

Try to spend an extra 10 minutes at each visit, providing patients with these “golden nuggets" of medical expertise and wisdom, and try to share reputable online resources where patients can continue to educate themselves on how to live a healthier lifestyle.