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|MainCategory=Ethics
|MainCategory=Ethics
|SubCategory=Cardiology
|SubCategory=Cardiology
|Prompt=A 47 year old male patient 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?
|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?
|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.
|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.
|AnswerA="Are you having difficulty paying for two medications at the same time?"
|AnswerA="Are you having difficulty paying for two medications at the same time?"
|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.
|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.
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|AnswerE="Do you think you are doing the right decision by stopping the medications?"
|AnswerE="Do you think you are doing the right decision by stopping the medications?"
|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.
|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.
|EducationalObjectives=Identifying the patient's concerns is key in cases of non-adherence.
|RightAnswer=B
|RightAnswer=B
|WBRKeyword=medication, adherence, non-adherence, nonadherence, nonadherent, non-adherent, metoprolol, aspirin, myocardial, infarction, coronary, artery, disease, disontinue, medications, medication
|WBRKeyword=medication, adherence, non-adherence, nonadherence, nonadherent, non-adherent, metoprolol, aspirin, myocardial, infarction, coronary, artery, disease, disontinue, medications, medication
|Approved=No
|Approved=No
}}
}}

Revision as of 12:59, 23 May 2014
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: ]]

Approved Approved::No
Keyword WBRKeyword::medication, WBRKeyword::adherence, WBRKeyword::non-adherence, WBRKeyword::nonadherence, WBRKeyword::nonadherent, WBRKeyword::non-adherent, WBRKeyword::metoprolol, WBRKeyword::aspirin, WBRKeyword::myocardial, WBRKeyword::infarction, WBRKeyword::coronary, WBRKeyword::artery, WBRKeyword::disease, WBRKeyword::disontinue, WBRKeyword::medications, WBRKeyword::medication
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