**EP47: Beating The Same Old Drums**
Welcome to Dr. Warwick's podcast channel. Warwick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warwick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love.
Hi, my name is Dr. Warwick Bishop, and I'd like to welcome you to my consulting room. Well, it's the end of a long day, and I'm just going to let you know that I'm going to jump on an old drum that I've beaten a few times before. In fact, I'm going to jump on a couple of old drums.
My last patient, who's a really nice bloke in his mid to late 60s, has had a heart attack and now has had bypass grafting. He turned up with some issues around muscle aches and pains, a bit of fluid retention, maybe some memory issues, and some cold feet. Well, this guy, I said to him, "Let me know what your tablets are," because his thought was that his tablets could be involved in some of his side effects. Well, you guessed it, he didn't know what tablets he was on. He didn't have a list. He said there's a blood pressure one and there's a cholesterol one.
Well, at the end of the day, with an inability to make some sensible decisions around possible management strategies, which require precision in my knowledge of exactly what he's on, that didn't help. I pointed out to him that this creates a little bit of frustration. In fact, I think it gave me a few extra grey hairs. I did take the opportunity to phone up his pharmacy, but you can imagine that takes 5 to 10 minutes out of a 15-minute consultation. I did it nonetheless because we really need that information.
By the time I got his information, we found he was on a beta blocker, which could have been the cause of his cold feet. We found he wasn't on any diuretic, so maybe he needed a tiny bit for the swelling he was describing. He had been on and off his cholesterol-lowering agents, but he had two cholesterol-lowering agents: one was a statin, and one was ezetimibe. He didn't know. Interestingly, he had stopped all his medications in the last few weeks and then restarted them without any change in his symptoms at all.
What am I sharing with you? A little bit of frustration. One is he probably didn't have a problem with his tablets; he just wanted to blame them rather than something else. And two, if we don't know what tablets he's on, we don't know where to start in terms of trying to answer questions about possible side effects of medications. As you might imagine, I made a strong advocacy to this man to make sure he writes down a list of his tablets and keeps it in his wallet.
In fact, on this occasion, because I got to speak to his pharmacist, I took the opportunity to ask his pharmacist to write a clear and up-to-date list that he can put in his wallet. This is so important because if this man ever were to turn up in an emergency situation, for example, at an accident emergency, having been hit on the head and was unconscious or after a car accident, his medications tell a story about his health that will help the people looking after him.
So if I can please, please ask you, write a list that's up to date of your medications and keep them in your wallet. That may just help a grumpy old doctor like me end the day on a smoother, happier note.
**Second Drum**
And this has happened a couple of times in the last week, so forgive me for beating this drum as well. But I've now had a couple of patients in the last few weeks who have come in and explained that because they weren't quite sure, they've unilaterally stopped their medications. Specifically, in this situation, because it's my area, statins. But it doesn't matter what medication.
I don't mind engaging patients in a conversation about the pros and cons of a particular medication and whether there's a side effect that could be affecting this patient. I have no issue with that. That's what I do. In fact, I think I'm reasonably good at it. What causes me great upset and distress is when people will make a unilateral decision without engaging me in a balanced discussion about the pros and cons and stop their medication because, well, they saw something on social media or because a neighbor said, "Oh, I had problems with that," or because some well-intentioned person has given them an idea that doesn't fit with exactly the clinical situation that I know is going on that prompted me to provide the script or that management strategy in the first place.
I want people to understand that preventative therapies don't make you feel any different. And so there isn't a reminder there every day that you need to take them to make you feel better. But they are there for you to have a longer life. And so my hope is you take a tablet, scratching your head, going, "Do I really need to take this for decades?" That's what I do—figure out how we change the risk in the future, how we make sure you can take a tablet that doesn't make you feel any different for the rest of your life and extend that life. Because at the end of the day, like my colleagues, we want you to live as well as possible for as long as possible, and the only way we can do that is by figuring out the pros and cons, the risks and benefits, and the best solution for you. And honestly, that's what we've trained for.
So please don't make unilateral decisions about your medications. Come and talk to the person who's put you on them so that that can all be done in a controlled, sensible way with sensible discussion and sensible risk evaluation.
Well, if you haven't figured out that those topics wind me up, you should listen to this again. It's the end of the day now. I've had my bit on the soapbox. I'm going to wish you the very best. I hope I've encouraged you to write your medications down, please. And if you have a problem with your medication or think you have a problem with your medication, don't stop it. Contact your doctor first and talk with them about it because it's for your benefit that you are on it. Be clear about the risk and benefit.
Okay, I'm not going to carry on anymore; otherwise, I'll get upset. I'm going to wish you the very best. I hope you've got something out of this. If you do have any questions or anything that you'd like me to cover in a podcast, please let us know, and I would endeavor to do that for you. Thank you for joining me, and as always, I wish you the very best. Goodbye.
You have been listening to another podcast from Dr. Warwick. Visit his website at drwarwickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.
