ts97
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A 56-year-old man has been nonadherent with his hypertensive medication. When questioned in the course of his regular office visit, he reports that he feels fine and just gets so busy that he forgets to take his pills. “I know this is a serious condition, “ he says, “but really doesn’t look like it is a thread to me.” According to the Health Belief model, what course of action by the physician is the most likely to increase his adherence in the future?
A. Have him attend a hypertension support group
B. Ensure that he has access to a pharmacy to get his prescription filled
C. Modify his prescription from a once a day to a three times a day dosage
D. Tell him a story about another patient who, like him, was asymptomatic with hypertension but who has recently died
E. Give him a pamphlet on the dangers of hypertension and ask him to talk to you after he reads it
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| cirus
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I thought about E but I dont think its appropriate to just give a pamphlet & not discuss it with him
so I'll go for A
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| usmlestud
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dd
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| dr in trouble
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A or E???
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| step3cracker
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I think it is D
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| ts97
Forum Senior
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The right answer is D in the notes. I thought it's a typo and it should be E. How can we tell scary stories to a patient?
"I new one guy like you, he is dead" !?
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| dr_arc
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answer D. relates to the anxiety performance curve. this pt is likely to start taking his medication if he gets anxious enough to worry abt his condition. a noncompliant pt who has been counselled by the doctor is less likely to respond to pamphlets abt the same. so scare him a litlle to get him to take the meds.
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| khorshid
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It sounds really inappropriate to tell your pt such a thing!!! Just imagine yourself saying "yeah you know he was asymptomatic like you and well guess what, he died!". A seems good, because these support groups always seem to be useful and a favorite of the ones who design qs.
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| khorshid
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I can imagine saying something like: yes and later he developed problems in his kidneys and vision and...telling pt about complications, but death ?
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| psysaji
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It is not possible in clinical set up to give pamphlet. even though he is reading the dangerous threat to him and it will not be to increase the adherence. Any way the option that given by you is quite confused.
My ans. is D
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| dr_arc
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hahahahaha khorshid i know it sounds so crude and offensive but that was the answer on the usmle world question and that was the gist of the explanantion. i agree i was shocked too..
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| DrVirgo
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I doubt its D!
I know thats what the answer says, but I clearly remember similar questions like this from Step 1 and scaring the patient into taking medications is ALWAYS the WRONG answer!
E -Patient Education to ensure adherence! He thinks HTN is NOT a threat to him..> Well, let him read about it in a small pamphlet.... so he can know the dangers of not being on medication. If there was a choice where the physician talks to the patient and explains the dangers of HTN and the benefits of being on meds, then that would be right, but in its absence this seems like the right choice.
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| khorshid
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eventhough I saw this in kaplan, if I see the exact same q on exam, i won't chose D, it may be mistypo or something. How come these guys who are so sensitive about ethics and even order of sentences you say, ask you to say such a thing. If I were the patient not only I would not take the medication, I would look for another physician to go to
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| dr_arc
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khorshid wrote:eventhough I saw this in kaplan, if I see the exact same q on exam, i won't chose D, it may be mistypo or something. How come these guys who are so sensitive about ethics and even order of sentences you say, ask you to say such a thing. If I were the patient not only I would not take the medication, I would look for another physician to go to
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| gr8doc
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I would have gone for either D or A. E is definitely not the answer, as he already knows that Hypertension is a dangerous disease so giving him pamphlets is not going to work. He feels that it is not a threat to him so either let him discuss the issue with a support group & find out all by himself about the disease consequences or just scare him to make him take medications.
May be I would have picked up A.
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| DrVirgo
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gr8doc wrote:
I would have gone for either D or A. E is definitely not the answer, as he already knows that Hypertension is a dangerous disease so giving him pamphlets is not going to work. He feels that it is not a threat to him so either let him discuss the issue with a support group & find out all by himself about the disease consequences or just scare him to make him take medications.
May be I would have picked up A.
Hypertension is known as the "silent killer".
If he is refusing to be compliant he obviously has NO idea about the consequences or dangers. Education is the first step. Then maybe a support group.
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| njcjzy
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Still confused. Can't agree with D because you are not supposed to scare your patients(step 1 concept I learned).
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| gr8doc
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He knows the consequences of the Hypertension , it is just that he doesn't want to accept that his disease is that severe. So I still believe that giving the pamphlet is not going to work here.
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