The two minute tutorials this week were themed around common drugs: Furosemide, Coamoxiclav, Metformin, Citalopram, Omeprazole. It is always useful to focus on those things that would otherwise be part of the background. It was clear that there were important actions one can take when assessing a patient taking one of these agents.
Has it been effective? Is it still needed? Can it be withdrawn? should that be rapid or slow? Are there warnings for the patient? do those warnings change the patient's views about using the treatment.
What sticks in my mind? Do not stop citalopram abruptly, warn patients on PPIs about infection risks (and how to reduce them), warn patients to stop metformin if they become breathless or are vomiting, beware clavulanic acid (coamoxiclav) with liver disease.
The reading this week was Bandolier: What patients think. A comment on the Original paper: PN Trewby et al. Are preventative drugs preventive enough? A study of patients' expectation of benefits from preventive drugs. Clinical Medicine 2002 2: 527-533. There seems to be a gap between the risk/benefit thresholds exhibited by doctors and patients, at least in so far as this study shows.
The Bandolier comment includes "This is an interesting and imaginative paper that tells us what patients think. Half were happy to take a preventive drug if the hypothetical five year absolute risk reduction was 20%, or an NNT of 5. ..... There is a clear discrepancy. Few preventive medicines for preventing heart attacks would seem to meet patient expectation.... the power of the doctor to advise. If their doctor recommended it, more than twice as many subjects would take the medicine. This, though, imposes a significant burden on doctors properly to inform their patients. Much less attention has been paid to how patients think about their own versus population benefit, and especially how the information is presented. "
Interesting topics this week:
Trigeminal neuralgia and Lyme disease
Next week's two minute talks are themed around spirochaetes (I hope Dr Jones has handed out the assignments).
The reading for next week is: Clinical craft: a lesson from Liverpool. D M Gore Journal of Medical Ethics 27:74-75 (2001)
MJM
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