This 51 year old railway worker has been on treatment for hypertension for a number of years but has only been on on my follow-up clinic for the last nine months or so. I noticed that his blood pressure readings were seldom consistent, some months were within normal limits, while others were high such as 160/100.
I suspect he has not been compliant in his medication. I informed him gently that unless he co-operates with the attending doctor, it would be a waste of time to come for regular visits to the clinic. As he was on a medication requiring him to take three times a day, I also cautioned him that he needed to take it at regular interval, every eight hours. I managed to explain in simple terms about drug concentration in blood and the concept of drug half-life and the effects on his blood pressure.
Well, he seemed to understand and started to take the medication according to instruction. His blood pressure seemed to stabilise within normal levels but then he started to complain of his heart "racing" every now and then at rest. As he was taking the drug regularly then , he began to experience its side-effects ( in some patients only), that is an increase in heart rate (nifedipine-induced tachycardia), brought about by this particular drug.
Under this circumstance, I told him I was going to change his medication to another class of anti-hypertensive to be taken once a day and for him to return to the clinic in a fortnight to see its effects on the blood pressure (BP).
He came today and his BP had gone up from 130/84 the last visit prior to the change of medication to 168/100 but his heart was no longer "racing. I asked him what had happened and whether he took the drug. And just to test him, I asked how many times he took the tablet in a day. He told me three times. I was aghast as the record showed once a day for the new drug. Then it dawned upon me that this patient could have been taking three times a day a medication which was supposed to be taken once a day!
I asked him to show me the tablets he was taking ( he had to return home to get them!), and sure enough my suspicion was confirmed.
The story was he took out the blister pack of the new drug and removed the plastic jacket on which the dosage and frequency were written. Then, according to him, he saw the old plastic jacket where three times a day was written and took the new drug according to that. Within a few days he started to feel uneasy, light-headed and his knee joints felt weak. He then stopped the medication on his own and so the high BP reading today! And those days that he had not been on medication.
Doctor and patient, especially one who is not well-educated, really need to communicate as the patient's understanding of medication is usually limited and this limitation can adversely affect their health. And in this case, a medical error had occurred due to the patient's lack of drug safety culture.
I suspect he has not been compliant in his medication. I informed him gently that unless he co-operates with the attending doctor, it would be a waste of time to come for regular visits to the clinic. As he was on a medication requiring him to take three times a day, I also cautioned him that he needed to take it at regular interval, every eight hours. I managed to explain in simple terms about drug concentration in blood and the concept of drug half-life and the effects on his blood pressure.
Well, he seemed to understand and started to take the medication according to instruction. His blood pressure seemed to stabilise within normal levels but then he started to complain of his heart "racing" every now and then at rest. As he was taking the drug regularly then , he began to experience its side-effects ( in some patients only), that is an increase in heart rate (nifedipine-induced tachycardia), brought about by this particular drug.
Under this circumstance, I told him I was going to change his medication to another class of anti-hypertensive to be taken once a day and for him to return to the clinic in a fortnight to see its effects on the blood pressure (BP).
He came today and his BP had gone up from 130/84 the last visit prior to the change of medication to 168/100 but his heart was no longer "racing. I asked him what had happened and whether he took the drug. And just to test him, I asked how many times he took the tablet in a day. He told me three times. I was aghast as the record showed once a day for the new drug. Then it dawned upon me that this patient could have been taking three times a day a medication which was supposed to be taken once a day!
I asked him to show me the tablets he was taking ( he had to return home to get them!), and sure enough my suspicion was confirmed.
The story was he took out the blister pack of the new drug and removed the plastic jacket on which the dosage and frequency were written. Then, according to him, he saw the old plastic jacket where three times a day was written and took the new drug according to that. Within a few days he started to feel uneasy, light-headed and his knee joints felt weak. He then stopped the medication on his own and so the high BP reading today! And those days that he had not been on medication.
Doctor and patient, especially one who is not well-educated, really need to communicate as the patient's understanding of medication is usually limited and this limitation can adversely affect their health. And in this case, a medical error had occurred due to the patient's lack of drug safety culture.
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