Take with food, report any side effects

As a physician, I admit to getting excited about new medicines. After all, they “fix” problems, “cure” disease — that’s why I became a doctor.

But is this really true? Do they always work great?

On reflecting a little more on this question, I realize that I know of no one who has never suffered a medication side effect. That is actually a pretty important fact: Every patient I have ever treated has, at some point in their lives, had a medication side effect of some sort. Thankfully, the vast majority of side effects are minor ones.

Of course, I include in “side effects” things like walletitis: the sudden sensation of nausea realizing the medication your doctor gave you is going to cost $100 a month.

Add the above to the more familiar “dry mouth, headache, dizziness” type of side effects, and you wouldn’t be blamed for thinking the cure may be worse than the disease.

Luckily, most family doctors realize this. Your primary care doctor probably prescribes generic medications for the most part, monitors blood levels when necessary, and tries to get you off medications through diet, exercise, quitting smoking and reducing sugar.

Well and good, but what to do when my patient comes in with a new, expensive medication I’ve only read about in the journals? Today was such a day.

Jim walked in after having had a near miss: He had a heart attack, and our team at Christiana Care took great care of him. He was helped in time and got a heart stent placed in one of his blood vessels. As he tried to recall the name of his new medicine, I wondered how much this was going to cost him.

After puzzling over the new drug names for a while, we eventually figured out the name. But Jim worried about ultimately not being able to afford it (for now, he had a month’s free supply). Also, no pharmacy except Christiana Care’s own carried it, at least for now, in our area. It reminded me that the best intended actions — the latest meds, the “best” treatment — are only good if the rest of the system is set up properly. At $7 a pill, this new medication potentially meant $2,500 a year. I could see a case of walletitis in this man’s future.

Intrigued, I called up his cardiologist, my colleague Dr. Henry Weiner. We discussed the results of the clinical trial that helped establish this new drug’s usefulness. I also asked him if he thought this new hotshot therapy would take the place of the pills we usually give — and if it was really worth the cost.

It’s always difficult to answer questions like this. But how we answer them as physicians is not nearly as important as how patients answer them. For that, they need their doctors’ best advice, information and even hearing “I’m not sure.” What’s right for one patient may not fit the circumstances of another.

As a physician who cares deeply about prevention, my job is to stop bad things from happening. But when they do, as they inevitably will, my role shifts to guiding best choices. Thanks to my colleagues at Christiana Care Health System and in the community, I’ve got lots of help, and that’s good news for my patients.