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By Rose Marie Robertson, M.D. Overall, only about half of all prescriptions written are taken properly. An even greater percentage of patients have trouble following a physician´s advice about a healthy diet, exercise and the need to stop smoking. In one study, about two-thirds of the patients admitted to a Los Angeles hospital with heart failure continued to smoke and drink after their release. In general, people who follow treatment recommendations stay well or get better. Because we know this, there is nothing sadder for physicians than watching the inevitable decline of patients who could do well. In recent years, I followed a young woman with diabetes and high cholesterol levels who, despite our best efforts, could not be persuaded to eat a healthy diet and take her medications properly to help manage her disease. Over a few years, her coronary arteries became increasingly clogged. By age 40, she was virtually housebound with a weakened heart, fatigue and continuous shortness of breath due to congestive heart failure. At the same time, I have seen other patients with similar problems who embrace healthy diets, exercise and carefully use appropriate medications, thus gaining many quality years of life. True, it can be difficult to take medication every day—especially for those conditions that rarely cause symptoms. I sometimes see patients who experience dizziness or actually faint when they stand up because they have dysautonomia or very low blood pressure. These patients have little difficulty following the diets and taking the medications I prescribe, because their symptoms remind them. My patients with high blood pressure or high cholesterol may be at much greater risk of premature death or disability, but they are not warned by symptoms and they don´t "feel" their risk day by day.
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