Hitting a Nerve
"What are the side effects?" How many times a day do you get asked that? Plenty, I’m sure. I certainly hear it.
The list of side effects (small print on the product insert) is enormous. No one can possibly cover them in the few minutes we have during a visit, so I just try to hit the ones that are most likely and those that are most serious.
Of course, most patients still go home and look them up. The majority of patients are fine with it, but some immediately develop every side effect imaginable through the power of suggestion. While I’m all for "empowered patients," the Internet is full of both useful and insanely inaccurate information. It’s often hard to tell them apart.
I still get asked for drugs "without any side effects" and try to explain that there is no such thing and never will be. The vagaries of human biochemistry are such that everyone will have a negative reaction to something sooner or later. And it generally can’t be predicted in advance.
I try to reassure people that just because a drug can cause an adverse reaction doesn’t mean that it will. I explain how most side effects were reported in a minority of patients, go over how the data are collected during trials, and so on. Most people are reasonable and understand that there’s a benefit-to-risk calculation we’re making, like anything else.
But some patients are quite adamant that as long as there’s even the slightest chance of them having a side effect, they don’t want to take it. They want help, but won’t let me help them. Those appointments are frustrating and make me wonder why the patient bothered to come in at all. They’re the reason I keep a wand next to my desk.
There is no shortage of treatments for at least some of the many conditions that neurologists treat, but at the same time there is always the chance that side effects will occur. Medicine, like everything else in life, has benefits and risks.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.