WBR0743

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Ethics
Sub Category	SubCategory::Cardiology
Prompt	[[Prompt::A 47-year-old male presents to the physician's office for his annual check-up. He has a past medical history significant for hypertension, dyslipidemia, and coronary artery disease with myocardial infarction 2 years ago. At the time, that patient underwent cardiac catheterization and has been prescribed metoprolol and aspirin since then. During history-taking, the patient tells the physician that he is not taking his medications because he feels they are bothering him. What is the best approach the physician can use to address the patient's non-adherence to his medications?]]
Answer A	AnswerA::"Are you having difficulty paying for two medications at the same time?"
Answer A Explanation	AnswerAExp::The patient did not describe any financial issues with his non-adherence. There is no reason the physician jumps into conclusions that may sometimes be inconvenient for the patient.
Answer B	AnswerB::"Can you please explain to me what bothers you with your medications?"
Answer B Explanation	AnswerBExp::Identifying with the patient's reason for non-adherence is key to address his real concerns and to find ways to re-adhere to his medications.
Answer C	AnswerC::"Taking your medications is important for secondary prevention of your coronary artery disease."
Answer C Explanation	AnswerCExp::Not understanding the real cause of the patient's concern is not helpful because the physician might be tackling what is irrelevant to the patient.
Answer D	AnswerD::"We can probably discontinue metoprolol so you don't have to take 2 medications at once."
Answer D Explanation	AnswerDExp::The patient did not address the issue of having too many medications to handle. Metoprolol is important for patients post-MI.
Answer E	AnswerE::"Do you think you are doing the right decision by stopping the medications?"
Answer E Explanation	AnswerEExp::Asking questions that might be judgmental might back-fire and worsen the patient' non-adherence. Physicians must refrain from conveying wrong messages while asking questions, even if non-deliberately.
Right Answer	RightAnswer::B
Explanation	[[Explanation::While facing such situations of non-adherence, the physician must be very careful to approach such topics with care to prevent offending the patient or even worse, breaking the patient's trust and further non-adherence. As such, the physician must fully understand what the patient's concerns are in order to address them objectively and effectively. There is no point in being judgmental or trying to assume why the patient is not receiving his medications without the patient clearly explaining his concerns. Educational Objective: Identifying the patient's concerns is key in cases of non-adherence. References: First Aid 2014 page 61]]
Approved	Approved::No
Keyword	WBRKeyword::Medication, WBRKeyword::Adherence, WBRKeyword::Non-adherence, WBRKeyword::Nonadherence, WBRKeyword::Nonadherent, WBRKeyword::Non-adherent, WBRKeyword::Metoprolol, WBRKeyword::Aspirin, WBRKeyword::Myocardial infarction, WBRKeyword::Coronary artery disease, WBRKeyword::Coronary, WBRKeyword::Artery, WBRKeyword::Disease
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