Treatment of ulcers: patient complianceQ. Patient compliance. What does that mean? A. Many people are professional pill-takers. They seem to love it, and will avidly watch the clock, work out large, written schedules and so on, and take their medication exactly as ordered by the doctor, come what may. But on the other hand, many patients are just the opposite. They hate medication, and dislike swallowing tablets for any reason. Therefore, they tend to forget, often by coincidence, but also, often on purpose. This is called patient non-compliance — the patient is not sticking to, or complying with, the doctor's recommendations. After all, the physician is recommending a routine which has been carefully worked out by the people who invented and researched the medication which is known to give the best possible results. So, by not complying, the patient is reducing the chances of the medication doing its prescribed function. That means, in healing the ulcer. From experience, doctors know that, in the main, the fewer tablets required, and the fewer actions needed, the more likely will the patient comply. Therefore, if medication taken once or twice a day gives the same benefits as medication taken four times a day, then so much the better. Q. Do you think some patients start and stop medication willy nilly, just as they see fit themselves? A. Most certainly and this is unwise, especially with cimetidine treatment. Many incorrectly translate symptom removal (or more correctly, pain removal) as a sign that the ulcer has healed, when in fact it has only commenced to heal. So they cease medication, only to find the pain rapidly returns. Often they will foolishly condemn the medication or the doctor when in truth it is their own fault entirely. This note is re-injected here to point out the desirability of compliance to directions. Q. In short, the patient should read the label and do as it says? A. Certainly. The doctor will tailor make the prescription routine to suit the patient, whether it be twice or four times a day, or any other system. From time to time, experience indicates that variations are desirable for the individual patient, and these may be translated into specific instructions. Please ... follow your physician's advice on medication at all times, and adhere to it rigidly. That is the best advice today. Q. After a patient has been relieved of his symptoms, and has taken medication as prescribed for the requisite length of time, what then? Is he cured forever, or, did I hear you say earlier, recurrences were possible? A. Although symptoms subside rapidly, and the ulcer heals more slowly, the majority may be cured of their ulcer with therapy. However, once treatment stops and acid production resumes, recurrences are likely, and do take place in many patients. Q. So what is the answer to ulcer recurrence? A. At present, the line of thinking is to keep the patient on a small maintenance dose of cimetidine. This will keep the acid levels of the stomach at a much lower level than in the pre-treatment era, and this may effectively prevent recurrences in many cases. The drug appears to be very safe, and it seems that long term therapy may be the ideal. The drug has not been available for a sufficiently long period of time to be absolutely certain of all this, but this is the current trend of thinking and line of therapy. So far, it appears to be working very well. *14\61\2* Gastrointestinal «Canada Online Pharmacy» |