Doctors & Drugs | Natural Health Blog

Date: 02/03/2011    Written by: Jon Barron

Prescriptions Not Filled

It's as predictable as snow in Montana: when you go to the doctor, you're going to leave with a prescription. Most doctors feel that they aren't doing their job if they don't routinely offer their patients pills or some form of medical "solution." They claim that patients expect and need drugs in order to heal, and the pharmaceutical companies wholeheartedly endorse that position. But a recent study shows that in fact, many patients who leave the office with a prescription never bother to get it filled.

The study, just published in the Journal of General Internal Medicine, found that of 75,000 prescriptions written over the course of a year in Massachusetts, 22% of them were never submitted to a pharmacy for filling. The rate of "noncompliance" was even higher for certain types of prescriptions. For instance, almost a third of first-time prescriptions (28%) were never filled.  The same goes for prescriptions for chronic conditions like diabetes and high blood pressure, which weren't filled 31% of the time. On the other hand, pain medication prescriptions garnered a far higher rate of noncompliance, with a whopping 65 percent of all prescriptions in this category never filled.

The researchers don't really know why so many patients never obtain the medications prescribed for them, but they do have a prescription to remedy the situation: better doctor-patient communication. "If [patients] do not fully understand the reason that they are being prescribed the medication, they may be less likely to take it," said Dr. Michael A. Fischer, of Brigham and Women's Hospital in Boston. "If you are not sure why you are being prescribed a medication, ask your doctor directly. One of our jobs as physicians is to educate and advise our patients, and being sure that they understand their medication regimen is a big part of that job."

Dr. Fischer suggests that many illnesses don't manifest disturbing symptoms, and so patients feel no critical need to rush to the drugstore for a cure. He feels that if doctors do not properly educate their patients, those patients will think bypassing the prescription is no big deal. The hole in Dr. Fischer's theory is the 65 percent of patients who fail to follow through on their pain medication prescription. Certainly patients in pain need no education to understand that the medication might diminish their discomfort. Still, they choose to forego their prescriptions.

Experts also point to the expense of prescription medication as a factor in noncompliance, although all the patients in the study had health insurance to cut the cost of drugs. And in fact, an earlier study by the Kaiser Foundation discovered that 29 percent of the people in the study never filled their prescriptions because of the expense, while 18 percent cut their medications in half for the same reason. This indicates that cost may well be a factor, even among those whose insurance covers part of the cost.

Other research has turned up similar results. In fact, the rate of non-filled prescriptions seems to be escalating. A study a few years ago found that between 2007 and 2008, the number of prescriptions ordered by physicians and then left at the drugstore rose by 22 percent. When compared to the year before that (2006), the increase in abandoned prescriptions rose by 34 percent. A separate study found that one in three diabetics failed to fill their prescriptions in 2009, and yet another concluded that a quarter of heart-attack survivors don't fill the prescriptions intended to prevent future attacks.

Naturally, the medical community finds patient resistance to filling prescriptions a worrisome trend. (I can only imagine what the pharmaceutical companies think.) And while it is true that cost may play a role in this scenario (a subject for a future discussion) and that poor doctor-patient communication may also factor in, it is equally possible that something else is going on. Perhaps the public has caught wind of the fact that prescription drugs are now the fourth leading cause of death in the US, just behind cancer, heart disease, and stroke -- not to mention hospital error, which we explored in a blog just a few days ago. Or perhaps they've heard that 2.2 million people in the US experience drug-related disabilities or serious drug reactions each year. Maybe they even know somebody who has been the victim of a drug reaction or prescribing error. Maybe they're smart enough to be scared by the page-long list of possible side effects that goes into the bag along with the bottle of pills. In fact, perhaps many people these days actually get on the internet and look up the drug they've been prescribed before ordering it. Maybe they even research the possibility of alternatives.

The reality is that although there is a role for pharmaceuticals in our healthcare, it doesn't take a Mensa member to recognize that prescription drugs cause lots of problems for lots of people, and that the cost (on all levels) sometimes isn't worth it for the benefit gained. Unfortunately, although that's true, it's also true that sometimes prescription drugs really can save lives, and a scared public may not be savvy about differentiating between useless, dangerous drugs and necessary ones. In one of the studies cited above, the 25 percent of heart-attack patients who opted not to fill their prescriptions after their cardiac arrest had an 80 percent higher death rate in the year following their attack compared to those patients who took the recommended medication. There's a case where education, in the form of data that patients could believe in, might have made a difference. Or then again, maybe they never acted on any of the alternatives they may have learned about, since those alternatives take discipline and require effort. And doing nothing is not usually a smart alternative.

And that's the point. Educating patients doesn't mean brainwashing them into accepting they must take their pills -- or else. To truly educate patients means that doctors need to give patients some credit for having brains--to let them see the statistics and weigh for themselves risks versus benefits. It also means that doctors need to present patients with alternatives when those exist and to support patients in following safe alternate regimens. Whether people take their medications or not isn't the point. The point is that health professionals need to assess what will help people to heal and to get stronger without creating even worse health problems as a result of the treatment. The healing community needs to do what it can to make sure that's where the emphasis resides, because that is what will create trust between doctors and patients and promote true communication.

Hiyaguha Cohen
jonbarron.org

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Comments

  •  
    Submitted by Guest on
    February 3, 2011 - 9:41pm

    Could it be that some of those who dont fill prescriptions because they realize the dangers of becoming a drug culture where every symptom is 'corrected' by another medication and likewise its side-effects are fixed by more (you gurssed it ) pills.

    I recently got out of the hospital where the doctors prescribed two simultaneous medications for hypertension. I've never had hypertension and while in that hospital my BP never went over 110/70. They prescribed a drug for stomach problems which I don't have and never have had. Reason given was I was to take aspirin while there. I've taken aspirin for going on 30 years with none of those problems yet they were sure pushing the purple pill. They also wanted me to take a sleep aide. I can sleep next to a busy railroad track at noon. Never had problems sleeping. Best way they could have assured me of sleep was to not come into my room ang wake me so often.

    Maybe people see through the un-necessary prescribing practices of many(most) in the medical profession. They do not diagnose, they prescribe. Of course the pharmaceutical companies love it!

  •  
    Submitted by mathew4512 on
    February 16, 2011 - 10:41pm

    I have never felt better in my life. I also do the Daniel fast that Daniel did in the bible.. that is veggies and water, while this fast seems like it would be easier it is not but it is a good fast for those who can not do a no food fast. And those who do it, just wait until you see how your body is actually supposed to work.. it is wonderful.

  •  
    Submitted by Damien woodi on
    February 19, 2011 - 8:56am

    It is true that vicodin is used to control pain but we must also learn their side effects. Findrxonline mentions that prescription medications must be recommended by the doctor but not patient.

  •  
    Submitted by L.P. on
    March 31, 2011 - 10:45pm

    I can't count the prescriptions I've left in the pharmacy over the last couple of years.
    I LET the doctor write whatever script he *thinks* I need, I take it home, do my research,and after being horrified at what I've read, take it to the pharmacy and act like I'm going to fill it....let them fill it, and 20 minutes later I go to pick my drug up....but I have changed my mind and tell them I want to research the drug first before I actually get it. Of course I never do pick up that drug. A few years ago a neurologist was a very script happy guy and wrote me several scripts and I dropped them off, but never picked any of them up. I had the pleasure of firing him. He was just another drug pusher for big pharma....Big Time...and when I tried to educate him about a rare disease that I have, he copped this arrogant attitude with me, and that did it for me. This is why I refuse to see mainstream doctors. I AM educated...and I do a lot of research, but most doctors resent their patients having any medical knowledge.

  •  
    Submitted by Alicia on
    September 20, 2017 - 11:54am

    If you have no intention of picking up the scripts, why on earth would you have them filled?!?! What an idiot. So, you think that bc your doctor prescribes meds you decide you don't want or need (which is totally fine), that gives you the right to waste the pharmacists' time and company's money, knowing you have no intention of paying for them? You do realize that when scripts are abandoned, the pharmacy can't give them to someone else, right? It's people like you who help to drive up the costs of health care in this country---all while lamenting that it's everyone else's fault...from hospitals, to insurance companies, to big pharma. NEWS FLASH- we ALL have a role to play in this fiasco and doing things like this, as well as using the ER as a primary care and not taking care of chronic conditions is a big part of the individual's fault.

  •  
    Submitted by Danae Taylor on
    July 15, 2011 - 12:38pm

    Excellent blog. Seduces me the idea to have more information on this blog, because I see that there are people who speak on the subject of concrete and fluid, that is why you've put in my favorites.

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