Notes on Nursing
Patient Education Prevents Complications
The easy way isn't always the best way
There are two things that most of my friends know about me. First, I try hard to stay in good physical health. Second, I’m passionate about delivering the message that you must be your own health care advocate. However, like lots of nurses I know I tell patients what to do while being in denial myself. Lack of attention to that message caused me a major problem last month. I have a seizure disorder, but I’ve been seizure-free for more than 15 years by taking daily medication and seeing a neurologist yearly.
Three years ago, when I asked for the necessary referral to see the neurologist, my primary medical doctor noted that because I’d been medically stable for such a long time she believed she could manage my care herself. It involved renewing my medication and monitoring the blood levels of Tegretol. Mistake #1: I assumed that she’d consulted with the neurologist on this.
I renewed my medication this year like I always do, through the mail order company that my insurance promotes with a low co-payment. This time, however, I received the generic equivalent. Mistake #2: I didn’t question this.
Last month I flew from my home in New Jersey to Reno, Nev., to visit a friend. My flight left at 7:30am, meaning I was up at 4am to get to the airport on time. The flights were delayed, and I ended up being awake for most of 24 hours before I finally got some sleep. I was up early the next morning, and because I’m at the gym three times a week I thought I was ready for a strenuous hike. Given that New Jersey is at sea level, and Reno at almost 5,000 feet, I was breathless five minutes in. Mistake #3: I assumed that because I run on a treadmill I’m ready for a steep hike at high altitude.
Later that day I had my first seizure in almost two decades. A consult with the neurologist revealed that lack of sleep and hypoxia were two big factors, but the switch to generic medication was probably the culprit. The specialist said that each year he sees three to four stable patients seize within two weeks of switching to generic anticonvulsants. By law a generic must deliver 80 to 125 percent of the active ingredient of its counterpart, so with a blood level that’s tightly controlled to a therapeutic level that small difference can be critical.
I tell you this personal story to help you understand just how important patient education can be. Many patients may opt for the cheapest or the easiest treatment, but that may not be in their best interest, and it may be up to you, as a nurse, to help them understand why. Insurance companies mean business and are looking closely at their own bottom line. We are responsible for protecting the health of our patients. It’s possible that can mean helping them find alternatives, but it can just as easily mean helping them understand why a specific medication needs to be taken or a procedure needs to be performed.
Be ready to question changes in the care plan, and don’t let the insurance policy dictate health care. Be informed and proactive. I wish I had been.
For more information on seizures, use the quick find box at: www.merck.com
For more information on patient education, see: http://patienteducationcenter.org
Christine Contillo, RN, BSN, has worked as a nurse since 1979 and has written extensively for various nursing publications, as well as The New York Times.