When is a medicine not a medicine

I know it sounds like the beginning of a joke like:

When is a door not a door – when it’s ajar!


This is far from a joke and a very serious question. A medicine, after all, is just a chemical in a pill.

But a medicine is far more than a medicine when it is part of a ‘treatment’. Let’s start at the beginning – it all starts with a human being. You see I don’t want to call them patients or clients or individuals – they are just ‘somebody’ at the beginning – ‘somebody with a problem’.

Showing you care  – as a healthcare professional I care – it says so in the title – so what does that mean? It suggests that I have time and I am interested. There is a saying:

“They don’t care what you know – until they know that you care”

So whether you WWHAM or you RAT it doesn’t matter unless you demonstrate that you care.

Understanding the issue – many people come in ask a question without really stating the issue. I have talked about that re insomnia where people say they can’t get to sleep, but their real problem is that they feel bad the next day. It is a real pity that some would knee jerk to prescribe a benzodiazepine or z drug and make the next day feel worse! So keep asking the question until the person describes their real problem.

Setting goals – this is very important. The goal setting is necessary for adjusting expectation. Someone with chronic pain is unlikely to improve by more than 2 points on a visual analogue scale – it’s not pain free – but it may allow some relief at some time of the day. And for targeting treatment when you decide which symptom is the one that needs action. You may not be able to target everything in one go – so start with the symptom that causes most problem, review and set new goals.

Creating texture – there are usually things that you can do – lifestyle changes – and coping strategies – psychological support – that constitutes the rest of the treatment package. These are the things that may allow the person to take less medicine in due course or even stop. They may allow the medicine to continue to work and arrest some of the factors leading to the symptom expression.

You have always heard the conversation – if you weren’t so fat your knee wouldn’t hurt so much – yes and if my knee didn’t hurt I would move about a bit more and lose weight. Sometimes a short term treatment might create a window of opportunity to change lifestyle enough to get on a path of recovery.

Selecting the medicine – There are many reasons to select specific medicines. Obviously I am going to base this on evidence of safety, efficacy and patient factors/experience. These are the most important, but I will also consider cost. Seldom have I been asked by a patient to treat something that is clearly an end point in a trial. People with diabetes don’t ask for something to bring down their HbA1c. This does require a higher level of investigation and interpretation to find the data that I really want.

Delivering the treatment – so do it. Deliver the treatment package including, if appropriate a medicine. Review what you are doing and make sure it is patient centred and with safety in mind. Check again that the person is engaged and still wants to go ahead. Make sure that there are not barriers that might get in the way of compliance and send them on their way.

Following up – check up on the person and on their progress in line with the expected patient experience. There are times when they will question the treatment and their progress and the future – just be there. But the most important thing here is to learn. My biggest problem here is that I don’t have those symptoms and I haven’t taken the treatment. I have read a book and a paper, but do please remember:

“Talking to people is the only real way to hear – caring is the only way to learn”


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