Patient goal - my goal

How many times have I heard a patient say "I just want to stop taking all these medicines!"

I reply, "I can understand that goal, but will you also consider the goal - I will do what needs to be done to 'treat to target' so that I can live without complications?"

They sigh and say yes. And I wonder if I can come up with a better response. Maybe it would be better to recommend earlier insulin initiation at this point. If the patient is on Metformin, TZD, glypizide combination -- the MDI insulin could allow them to stop the TZD and glypizide, right?

It doesn't seem ethical to let them believe that with plenty of exercise and eating just right, they will eventually get off the medicine since I know that diabetes is a progressive disease.

The really sad part of each of the goals is that for many of the patients, we are not even close to reaching either one. If there is a way to bring the patient on board for 'treat to target', I'm sure it would increase the probability of reaching the goal. The patient could hold the healthteam accountable and ask for titration and adjustment of the medication to reach target. Maybe the medications would not seem like such a burden to the patient if he/she had a greater understanding of their impact and had more control of the adjustment of them to reach target.

I believe in the future, I will encourage my patients to become cheerleaders who chant "treat to target, treat to target, treat to target" and provide them information to participate in reaching that goal.

I will also seriously look at their medication list to assure that any combo drugs that are available are being used -- even reducing two pills to one combo pill would demonstrate that I heard their goal and want to help them achieve it.