Pill Pusher

Most days at work I feel like a pill pusher. "Take this orange pill for your high cholesterol, this little white one to lower your blood pressure, these two big white ones for your chronic lower back pain, a big green one for calcium supplementation and this injection goes into your stomach to help prevent a blood clot from forming in your legs that could potentially travel to your lungs or heart and cause huge problems." I got into nursing because I am passionate about preventive health care. Yet here I am "pill pushing," granted I will say when patients question that they need a certain med, after educating then I do inform patients if they are uncomfortable taking some of there they have the right to refuse. But they rarely do because 1) they were already taking all these meds at home, 2) the doctor prescribed all these for them, so aren't they important?

Which leads back to doctors education and the huge HUGE influence US pharmaceutical companies play in which meds people take. Have you noticed the insane amounts of TV and magazine ads offering a pill to treat high blood pressure, atherosclerosis (say that ten times fast), high cholesterol, and depression? I will stop myself here because I could write for hours about all of this. If you are really interested consider reading "Overdosed America" or "The Truth About the Drug Companies", but take a different spin on how drug companies do not report all the research trials they do, just the ones that support the use of their, and these results are published in respected journals that doctors read to learn about the latest and greatest.

Back to the preventive education idea...Instead of giving the aforementioned pills I'd love to say (assuming this is not a critical patient) "Here are some supportive running shoes, walk a mile a day to decrease your blood pressure, lower your cholesterol, and stop eating high fat, highly processed foods, increase your calcium intake through leafy greens. And in 2+ weeks your lower back should not hurt as much, you should feel your mood has improved and additionally you may see you have lost weight, which would make all the problems you were taking pills for better as well. Oh and as for anticoagulant, if you are over 60 or have a history of heart problems take a baby aspirin everyday (as long as you do not have a clotting issue). By eating well and exercising you should see that you save well over $1000 a year in medication costs."

But why don't we do medicine like this? Because it takes more time to counsel someone on lifestyle changes than it does to write a prescription for a pill that might solve the problem at hand. It is not just the doctors and nurse practitioners that are to blame (and some really do benefit form pills). The vast majority of people do not want to put forth the energy to change their lifestyle. Taking a pill is easier, it is culturally acceptable, even encouraged, especially by our media heavy society. But the most healthy are ordinarily those who take the least amount of pills, using diet and exercise to achieve health.

Every few weeks I have a patient in their late 90s. I love them and think we really need to honor older people more than we do. The healthiest older patients I have generally take less than 5 medications, of which 3 of these are vitamin supplements and at least one is a prescription eye drop. They are at the hospital because of an infection that needs IV antibiotics or because they broke their hip, but we don't expect them to stay long.

Sad case: I had a patient who came in with chest pain, so we were working him up as a "cardiac rule out" to see if he had a heart attack or not. He had all the risk factors for multiple health problems: heart attack before he turned 50, high cholesterol, insulin dependent diabetes, high blood pressure, smoker. This man benefits from meds for his conditions. But his health would be greatly improved by diet and exercise. I had a long talk with him about changing his diet to minimize his risk factors for illness. What broke my nurse heart was his response, "I want to eat better, I do try, but with how little money I make I cannot afford to eat fruits and vegetables daily because they are expensive while my meds are covered by insurance." For me this is a reality check. I am so fortunate to be in good health, with reasonably healthy genes, with the financial means to all the fruits and vegetables I want (albeit I cannot afford organic). I do take 3 pills daily: a prenatal (kidless at present, but I plan ahead), folic acid (I was anemic years ago), and Vitamin D (because all people in Washington are deficient in D).