What Does Medication Choice Mean To You?

I was recently asked " What does medication choice mean to me?"  Yikes, this is a large and complex issue.  At first, I wasn't sure what my reply was going to be. To some degree, I didn't think about having a choice, I was a good little, slightly naive patient and I pretty much did what my doctor told me to do.  I guess it only take one not so positive experience before you take a deeper look at this question. If I had not had a situation in which I did not have improvement on a current therapy that my doctor was prescribing, I would not have advocated for further choice or greater exploration. I started to break down this question. To have medication choice, a person would firstly need to simply have choice. As a severe asthmatic, I did not always have choice. I had tried just about every inhaler that was on the market at one time. I finally found a combination that worked. I think it is important to note that there are a lot of factors in asthma control which I believe effect choice. Adherence to medication protocols, medication effectiveness, concerns over side effects, etc.

In a study that looked at medication adherence from the perspective of chronic disease patients, it was found that, “some patients expressed beliefs that led them to non-adherent conducts such as considering drugs as chemicals or toxic products and that they create a vicious cycle, and a confidence in spontaneous organic recovery without treatment.”1

"There were some study participants that showed a clear preference not to take any medication, but they accepted it with a certain feeling of defeat and resignation. They considered that medication was often prescribed routinely and that health professionals did not contemplate possible changes in health status so as to reduce drug dose. They felt that in some way, a drug prescription was a consequence of a lack of time or resources for other types of treatments. Some of them identified the pill burden as a trend imposed by the health system as an alternative to tailoring treatment."2

I have certainly had some similar feelings on occasion, it seems like every gathering of people can lead to a story about a patient being offered a script in record time and not feeling heard. As a patient advocate, I think there are ways to be prepared for appointment and be a bit demanding of the care that you need. There is a direct correlation that if you are part of the process of deciding treatment options, that you will be more adherent.  I know that I have a personal story of being so frustrated of being offered yet another steroid inhaler without any answer about what was actually happening from an inflammation standpoint or a plan to get me on a path to better health that I threw the inhaler across the room. It broke apart and ended up being a costly outburst. It wasn't one of my finer moments but it did give me the strength to have a more in-depth conversation with my doctor about "our" treatment plan.

Without going too deep into insurance rabbit holes, honestly, I am having my own insurance woes right now and policies are all different and there are lots of motivators for choice not being in a patients’ control.  As you can imagine, a lot of these are fiscally based decisions. I certainly have my own concerns about succumbing to treatment based on what is affordable, rather than what is the most effective for me. That will be a conversation for another day.

What do you consider to be the most important component that drives your medication choices?

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