Discussing drugs with your
patients can be a fine line between honoring your vitalistic ideals and avoiding
a lawsuit.
By Amy Dusek
The statistics are grim: More than 1 million Americans annually are poisoned
by over-the-counter (OTC) and prescription medications and other sources. One
out of seven hospital beds is taken up by a patient who is experiencing adverse
effects of OTC and prescribed drugs. Over 16,000 people in the United States
die each year because of gastro-intestinal bleeding from arthritis medication.
(Note: Many of these medications can be purchased without a prescription. The
dosage is not controlled and people often take them improperly.)
Chances are, every day of practice you are sought for counsel on drugs. Discussing
medications and over-the-counter drugs is a conversation that can have direct
consequences for your patient and you.
“There is a fine line we cannot cross,” says Andrew Krantz, D.C.,
of Marietta, Ga. “We cannot practice medicine. To tell a patient to go
on or off a drug—whether over-the-counter or prescription—is not
within the scope of any state’s chiropractic license.”
David Lee, D.C., Ph.D, C.A.D., has a 100 percent cash practice, also in Marietta.
His practice is holistic and what he describes as “out of the box.”
“I see most of my patients one hour at a time,” says Lee. “Forty-two
percent of my patients have already received a terminal diagnosis from a medical
provider. I don’t see very many neck and back pain cases. I get the people
with breast cancer and liver failure—they’re on lots of medications.”
Lee takes a direct approach with his patients and their team of medical doctors.
Once Lee determines the treatment needed for his patient, he sends their doctor
a note explaining what he plans to do. “Most of the time it’s one-way
communication,” says Lee.
“My job is not to take patients off medication. My field is chiropractic,”
says Lee. “My job is to get them so well that their own doctor will take
them off the medication.”
In addition to his chiropractic training, Krantz is also a post-graduate state-certified
level two EMS instructor, a board certified paramedic and state instructor.
He has seen the lethal effects of drugs through professional and personal experiences.
“This has become a passionate topic for me since I became a paramedical
instructor in 1965. I witnessed patients being transported from their homes
to the hospital with life-threatening emergencies not from trauma, but rather
from medications taken in improper sequence or improperly mixed with foods and
herbs,” says Krantz, who has been in practice for nearly 30 years. “In
1975 I began chiropractic college at Life University, and that’s where
I really became educated.”
During his studies and early years of practice Krantz became aware of how the
medical establishment works with pharmaceutical drug companies. “Pharmaceuitcal
companies are in business to make profits, and I also realized young in my career
that the worst nightmare for pharmaceuticals would be an epidemic of good health.”
With drug ads prevalent on television and magazines, in many patients’
minds it adds credibility to new diseases and disorders and plants the seed
that drugs should play a role in their daily health. “Remember the saying,
‘An apple a day keeps the doctor away?’ It was true, apples are
full of nutrition, vitamins and minerals. Now, when you watch TV you see [people]
taking an aspirin a day to keep heart attacks away,” says Krantz. “The
problem is that on these drug ads you never hear the downside of kidney and
liver failure. So people watch TV, see the ads and ask their doctors to prescribe
the medications.”
Krantz cites a breakdown in communication and lack of education between patients,
doctors and pharmacists as the cause of many life-threatening drug reactions.
Too many times, he says, patients are uneducated, they have more than one doctor
and they may go to multiple pharmacies to fill prescriptions, and no one catches
lethal drug combinations. “When the chain is broken, that’s how
lives are lost,” says Krantz.
“In every day of practice, patients present to their chiropractor numerous
symptoms. It becomes important that we distinguish the symptoms related to the
spine and musculo-skeletal system, and the symptoms of poor reaction to drugs
or drugs that cause problems when taken with certain foods or herbs,”
says Lee.
Even though chiropractors are not in the business of prescribing drugs, there
is the responsibility of educating the patient.
“In my office I recommend [patients] buy ‘The Pill Book’ [by
Harold Silverman] and the ‘Physician’s Desk Reference,’”
says Krantz. “I also encourage them to develop a relationship with their
pharmacist.”
Krantz’s passion for discussing drugs with patients also stems from a
life altering experience of medical mismanagement affecting his mother, Rose.
During a visit in 1992, Rose developed a blood infection from a doctor-recommended
flu shot she had received before her trip to Marietta. Seeing his mother’s
condition deteriorating Krantz found her the best medical doctor in Georgia
and did everything in his power to ensure that she received the best care. Krantz
made sure her room was near the nurse’s station. The doctor put Rose on
IV antibiotics for eight weeks, but told Krantz that he didn’t expect
her to live beyond three weeks. So, Krantz made sure to visit three times daily
to check her spine and give her adjustments. He also brought in Dr. Sid Williams
to visit her and give her adjustments.
After three weeks Rose had totally recovered. “I know it wasn’t
just the antibiotics that did it, it was the chiropractic care,” says
Krantz. Rose’s discharge was set for a Thursday and Krantz began organizing
a party. “On Wednesday I saw my mom, she was beautiful and completely
recovered,” recalls Krantz. “On Thursday morning at 4 a.m. her nurse—a
critical care nurse—made a mistake and gave her IV insulin. It was the
wrong drug, wrong patient, wrong doctor, wrong room. Four wrongs.”
The medical staff didn’t check on Rose for more than five hours. When
they did, she was lifeless. “They initiated advanced life support, but
she was gone.”
It’s not the easiest row to hoe for Krantz, but he continues to do what
he can to prevent others from losing their loved ones to lethal drug combinations
and improper use.
“As a chiropractor, my responsibility is big—it’s more than
just treating the spine. My responsibility is to the patient, to educate them
and prevent them from harm. So I become their mentor and I direct them to references,
such as the ‘Physicians Desk Reference,’ and direct them to their
pharmacist and encourage communication,” says Krantz. “They listen
to me because of my loss and the tragedy I experienced.”
Editor’s note: Since Rose’s death there is now a national Rose Krantz
protocol for IV administration of lethal drugs, such as insulin and antibiotics.
There is also a national scholarship fund for nurses in Rose’s name.