Only You and Your Doctor Can Make That Decision

“Only you and your doctor can make that decision.”

Celebrex. That’s the commercial where I heard this statement, spoken in a smooth, silky female voice. (Celebrex is prescribed mainly for arthritis.) And it got me thinking…

I love the idea of making a decision with an expert or professional. They’re the expert, and I’m the one with this idea, and together we’ll sort things through. Sounds excellent, doesn’t it?

But my idea isn’t really mine, is it? The advertisement put the idea into my head, to “talk to my doctor.” So I’m really just parroting someone else’s idea. I’m already starting to lose my enthusiasm a bit for this idea.

Which brings me to me making a medication decision with my doctor. What’s a decision? A decision is to make a final choice or judgment about something or to infer something on the basis of evidence.

It really sounds like we’re partners in this big, momentous decision. I mean, the Celebrex ad (YouTube link of the actual ad) goes on and on for what seems like 2 minutes or more… The voice just keeps talking and talking and talking. It sounds like I’m contemplating brain surgery or something with my doc.

Choosing a drug isn’t like making a decision about brain surgery, however, and it’s not really much of a decision. For me to be an informed decision-maker, I’d have to go and research this whole class of medications (the “evidence”) to even begin to understand whether Celebrex was “right for me.” And even after I did that, I still wouldn’t have the actual hands-on experience in prescribing it (or taking it) that my doctor does. And I’m making an assumption most patients make — that my doctor actually knows the full breadth and scope of research and evidence, and can help inform my choices. (As we’re learning more and more, that is often simply not the case for many physicians, because the amount of evidence to keep up with in general practice is simply overwhelming and virtually impossible.)

It gets worse, though. My doctor has only a vague idea of how any given person is going to react to any given medication. Have you seen the side-effects list for virtually any medication on the market today? Most include dozens of possible side-effects, many of which are common. (Here’s the list for Celebrex, which includes these most common side effects — Abdominal pain, Diarrhea, Dyspepsia, Flatulence, Nausea, Back pain, Peripheral edema, Injury-accidental, Dizziness, Headache, Insomnia, Pharyngitis, Rhinitis, Sinusitis, Upper respiratory tract infection, and Rash.)

What the patient information sheet doesn’t tell you is that neither you nor your doctor knows in advance which side effects you’ll experience while on this medication. It’s simply trial and error. And guess what? Celebrex’s competitors have similar side effect profiles.

So while it sounds really good to make a decision with your doctor, it’s virtually meaningless — the decision isn’t really that big a deal. Try X medication, if it doesn’t work or gives you bad side effects, we’ll move on to Y medication. Yes, there’s some art to this process (and that’s where a good doctor distinguishes herself from a bad one pretty quickly), and certainly your doctor’s experience helps somewhat.

I feel badly that there’s not much of a decision to be made, and if there is one, it’s largely based upon the trial-and-error process (all other things being equal, such as whether other conditions preclude me from taking the medication in the first place). I want to be a partner in my medication decisions, but it feels like I’d mostly be the one on the receiving end of the decision… The doctor is the one with the prescribing pad, so at the end of the day, it’s really her decision to write the prescription, and mine to actually go home, fill it, and take the medication. It’s not like we’re having an intellectual conversation that goes like,

“Well, what do you think about the Johnson & Shultze 2004 study that showed Celebrex might increase my proclivity for cheese?”

“Good point. Are you allergic to cheese?”

“No, I just don’t eat it.”

“Ah, well then, let’s try something else…”

There, decision made. And that took less time than the commercial.