I've noticed another trend in my stroke population. More and more patients are being admitted with strokes because they haven't been taking their medicine. The frequency has increased from one or two a month to at least that many in a week. This morning, I evaluated three patients who weren't taking their antihypertensive medications. All had NIHSS scores greater than 12, which isn't good.
There are many reasons why patients don't take their medication. Surprisingly, medicine cost is rarely the reason. Most of them just stop taking the medicine because they felt OK and didn't think they needed to continue. There is a sort of sad logic to that. Of course they felt better. The medicines were doing what they were supposed to be doing.
I've also noticed that strokes resulting from medical noncompliance seem to more severe. These people usually don't go home in a couple days. They have strokes that require prolonged hospitalization, inpatient therapy and disability. All three of my evaluations from this morning will go to a SNF when they leave my hospital.
People must not understand the relationship between medicine and stroke prevention. I've heard patients ask if the stroke was related to not taking medicine. Others are just surprised. No one believes anything bad will happen if they stop taking their medicine. There seems to be a disconnect between not taking medicine and bad outcomes. No one thinks it will happen.
This is one of those times I would like to take some pictures of my patients and post them elsewhere in the hospital with the heading, "This is what happens when you don't take your medicine." Obviously I can't. It wouldn't do any good if I did because the guilty wouldn't recognize themselves. Taking medication is the easiest way to prevent a stroke. Yet people won't do it.
I know my population is very unique. I only work with stroke patients so I see this sort of thing more frequently. But I see it too frequently. It will probably get worse if the economy doesn't improve. Inability to afford medication could become a significant problem.
This means we'll be seeing more stroke patients in our practices. It also means a greater demand on PT services. Stroke patients tend to require therapy longer than other diagnoses. There is nothing we can do about it until the patients come into our care. By then the damage is done and we're trying to make the best of a situation that could have been prevented. That statement is what bothers me most about this. The majority of these strokes could have been prevented by simply taking medication.