North Carolina People; Joe and Terry Graedon, The People's Pharmacy

Anything that is no gentleman. We have two friends on North Carolina people tonight. Bill and Terry Graydon. Few people I know have had the impact they have had on our good helps the People's Pharmacy and a dozen more have taught us all about medications and drug interaction in a very constructive and important way. They have appeared on Oprah Winfrey and Good Morning America and the Today show. That there are a lot of people. Who are proud. To talk with him and just a few second. Funding for North Carolina people that's provided in part by Will's Fargo. When you want to bank with greater accessibility Wells Fargo is with you giving you the tools to help you stay connected. We'll so far go together. We'll go for. And through the financial contributions of viewers like you who invite you to join them in supporting you in CTV. Friends this is the new book. I'm Joe and Terry Graydon.

Top screw ups doctors make and how to avoid them. It's a great book. I've been working on it and through it and that it was I'm one of those in the geriatric category they spend a lot of time on so of course I'm interested. But I'm so pleased that we could get them over here to talk about a little bit. And good to see both of you again. Thank you so much. We want your help. Great to be with you. You know and you certainly are moving around with this new text everybody who was to talk to you about I don't you know well it has been controversial and not surprisingly a lot of physicians are a little bit concerned about the title but I think a lot of people also want to know how to protect themselves and the people they love from Medical Harm. The inspiration for the book came from something that was deeply personal to you Joe. It inspired me to get the job done the way it is done here and tell the real story. It certainly was an important factor. You know we have been writing about

deadly drug interactions for 35 years. It's been one of the things that we have been most concerned about. And yet I couldn't protect my own mom from such a drug interaction problem. She had to go into the hospital and while she was there they did what was considered a minor procedure angioplasty of one car an airy artery. Now this is a woman who is 92 sharp as a tack and full of life still absolutely fascinated with everything going on around her and still curious about life and thought she had many many good years to go which is why she underwent the procedure and everything went really really well. The intervention a cardiologist came up and showed me the pictures afterwards and said Look at this this is great she is going to be so happy with the results and she was she looked fabulous.

But I left after about three or four hours to go home and grab a little bite to eat. And at 2:00 o'clock of that morning I got a call Joe I've been poisoned. And come quick was what she said when I got there. She had her teeth her feet were tied to the bed she was thrashing uncontrollably panicked fearful. Turns out that a doctor had injected Demerol into her and her intravenous line at 10 p.m. while she was asleep and it had led to something called serotonin syndrome which can be deadly. And in her case it led to hemorrhage and death. The next morning should have happened. That's a very delicate story for you to share that. It's a hard story for me to share and I I guess what I was trying to do with Terri's help in this book was perhaps prevent that sort of tragedy from happening to anyone else there that leads me to ask you this

question. You know doctors in too great a hurry today. Well they're forced to be in too big of a hurry in most cases. They only have seven or eight minutes at. An office consol. They the way that the reimbursement system is set up is almost like a treadmill. Doctors have to keep going in order to be able to make ends meet. So yes doctors are often in too big of a hurry and that that's a real problem for all of us. Bill how much is technology now accelerating all of this. Well technology is a it's a blessing but it can be a curse sometimes. And if a doctor doesn't take time to listen if the doctor is so busy entering information into the computer that the doctor isn't actually spending time you know eye contact which is so important. The technology can get in the way that we sometimes realize so much on the procedures

on the testing on the C.T. scans all of this wonderful technology that no question about it saves lives. But when we lose that personal contact that that ability to listen the ability to understand all of the medications to be able to really communicate back and forth in a way that really leads to change. Without that medicine will be lost if it just relies on technology. And that's the way of the patient being admitted the diagnostician and well you know that communications I was talking about does take time. And yes we're we're not equipped to be diagnostician and no we haven't been to medical school. And yet it's actually surprisingly difficult for doctors to even make difficult diagnoses. Well one of the things that we discovered in doing the research for this book was that diagnostic mistakes are way more common than anybody

ever realized. I certainly had no idea anywhere from 5 to 15 percent of patients are mis diagnosed. One hundred thousand patients die every year from mis diagnosis. And so as a result patients sometimes can use the Internet to find out what some of their symptoms may be leading towards. So that they can have a very intelligent conversation with their doctor. Why such a high incidence of their own. Well I think there are a couple of things one is you mentioned it already not enough time. So doctors make sometimes a very quick diagnosis and then error gets to be quite frank. Once a doctor makes a decision this is what ails you. It's sometimes hard to go back and consider other possibilities. Dr. Jerry Groopman one of the great doctors in this country who's written marvelous books one called How Doctors Think cause that anchoring. And the idea is that once the doctor throws out his anchor or her anchor into a

potential diagnosis it's very difficult for them to let go of that idea and to consider whether any of the symptoms that you're presenting with Mr. Friday don't actually fit this diagnosis. The doctors come up with. So here's the important question. How confident are you Doctor that this is what my diagnosis is. And number two what else could it be. So you're in production and here it is don't be a passive patient. Exactly. It's really critical for all of us to be engaged in our health care. We need to be partners with our health care providers not just passive recipients of health care. So when you get a prescription What is it. Why am I taking it how do I take it. What are the most common side effects because all medications have side effects. What are the most dangerous side effects and they would require me to contact you immediately or go right to the emergency department. We've learned for example and it just astonishes

us that one of the categories of blood pressure pills called what we refer to as ACE inhibitors. The Senate Pro ram approval captive prevail and that there are a whole bunch of them. There are marvelous drugs they save lives no question about it but they can cause a very bad cough. This is the kind of cough that keeps you awake at night sometimes it makes you throw up. It can ruin the quality of your life if patients don't know about that side effect. And to contact their doctor and be switched to a different drug it can absolutely change your life and we've heard from hundreds of people who were never told your listeners can cause a cough now. You've been talking most of the time about symptoms and people in the age of 40 to 60. 91 years of age. What should you medication surveillance. What's the difference. You know there's a hole the minute you pass a certain age and it's not like you know 84. We can't we can't say you know

everything changes once you're 65 in three days. But but things do change as we grow older our bodies become more complicated our health conditions become more complicated we tend to accumulate more health conditions and consequently we accumulate more medications and more potential problems with them. Here's the big problem in this country we don't value geriatricians the the physicians who specialize in treating older people. So it's kind of considered the bottom of the totem pole. They get paid the least. Even though they often know the most about how to prescribe and treat an older person. So the problem is there are a lot of medications that should never be prescribed to an older person. There are a couple of lists in the book one is called the beers list. Yes this was a physician who said these are drugs that just should never be prescribed or only under very rare circumstances because they can cause all kinds of other complications. There's another

category of medicines we call them anticholinergic so they can scramble your brain and the more of this kind of medicine you take the more scrambled you become confused loss of memory just inability to make common decisions now and that point excuse me to go ahead. It's a great deal of misdiagnoses they are saying people have all the time or you know have it that's nice and what about you know yet. Because if you are taking several of these medications perhaps perhaps they have nothing to do with your cognitive function in terms of treating it you know it might be a medication for overactive bladder in another. Medications for heart disease and another medication for something else. All you know seemingly legitimate treatments that you might need. And yet the combination can make you have cognitive decline and the doctor says well you know what you expect here. Yeah 88 and

you know it's just too bad but your synapses aren't snapping any longer. But that's not necessarily the case. If these medications are changed if they're substituted for something that doesn't affect cognitive function the patient can actually sometimes make a remarkable recovery. Or you have a case history and years where the very dramatic could really be the patient himself started saying so much better. You know what I can do. That's right. We've heard from so many families who have said you know. Grandma or dad or mom they were kind of going downhill they were able to really take care of themself the way they should. You know there were Simba Staton to lower their cholesterol there was the Tylenol PM that they were taking at night to go to sleep. There was the anti-anxiety medicine as Terri said some of the heartburn medicines even something you can buy over-the-counter called Sime editing or tag. All of these strokes together can have this anticholinergic effect that can make people just confused and a doctor who's not paying careful

attention may say oh all Simers disease get ready for the nursing home when changing the medications might make a huge difference. Then they jump way ahead. I'm watching the nightly news. See this story about heart disease medication. Only one hospital only 15 patients. Is there a danger now that we do this kind of thing move people too fast. Well. Heart failure is one of the leading killers in this country today and people get confused we're not talking about clogged arteries. We're talking about a heart that is not pumping the way it's supposed to. And when the when the heart starts to enlarge and can't pump well people can't breathe very well they have a hard time walking their whole lives really become a challenge. So the stem cell research is very exciting and does represent a possible game

changer in the treatment of heart failure. But we're a long way from adopting this technology it's many years yet before we prove how effective it is and how it should be administered. There is a very inexpensive drug. It's a diuretic. It's called Sparano lacto generic So it's very inexpensive should be prescribed far more frequently to patients with heart failure. One of the things we discovered in this book is it frequently is not prescribed. We can't understand why all the guidelines suggest it should be so until we have stem cell research that shows yes this is going to really be effective. There are some other things that people with heart failure could be doing that could spare their hearts or at least make their situation much better. One of the things I learned from reading behind you is how much emphasis you you put on the patient. No went back to think about my own experience how assertive was I should be and

what advice you say right off the top you had Terry who you were talking to the women society Tamar. Give them three Ru sure you know how we say war is too important to leave it to the general health is much too important to leave it completely to the doctors. So one of the roles is really you need to know what your diagnosis is and what you should be doing for it. So you need to understand what your doctor has told you about your condition and you may actually need to go beyond what your doctor has told you and get more information. The other thing that's important is to always have an advocate with you. If you're in a doctor's office and the doctor gives you any bad news whatsoever you will shut down. I mean your brain will go into the stratosphere and you won't hear very much from that. You may be sitting there nodding. You're here but you're not here and I know it. Yeah and you also need to be really well organized before you see the physician

so that you can tell him or her exactly what the most worrisome problems are that you're trying to deal with. You know if you've been coughing up blood don't believe that when the end of the doctor's visit you need to get to it right up front. You know you mentioned assertiveness. And I think there is nothing more important if you're in the hospital and somebody wants to give you a medicine or have you undergo a procedure and you're a little unclear about it or your advocate is unclear about it. There is one marvelous word no. When you say no in a hospital it's like throwing a monkey wrench into the machinery First of all there sir. Oh how can that be. How do you know. And what you're all you're asking is I need clarification I need the attending physician to come by and explain why I'm taking this medicine and what you want to do to me. And if it's explained thoroughly into your satisfaction or your satisfaction of your advocate then of course you go forward. But if you're a little uncertain and saying no is important because being a good

patient can get shit dead. Being in a quiet place again. Exactly. Going along without understanding because that medication your nurses brought you in a little cup then you've never seen before. It might not be meant for you. It's possible it was meant for somebody in the another bed doing talking with people in the farmers who were there to tell you it takes a hundred million dollars to bring a drug from one idea to the market. How in the world do you two keep up. With the flood of dates that are coming out. This is a big big businesses worldwide. It's instantaneous. You know when it is measured something in Singapore I do you do it. Well first of all it actually costs more than 100 million now believe it or not it's closer to a billion really. It's it's unbelievable how expensive it is to create a new medicine which is one of the reasons why we haven't had so many breakthroughs for all Simers

for some of the big killers like cancer there are advances but we haven't had the big breakthrough that we've all been warning for so long. Well this is all we do. I mean I feel sorry for a physician who has to see patients all day. You know sometimes from 7:00 in the morning until 8:00 at night. It makes rounds has to make the phone calls at the end of the day and then comes home exhausted and just has barely enough time to look at a journal or two in that specialty if they're a cardiologist or a gastroenterologist. All we do is review medical literature day in and day out. And so we try to the best of our ability to stay on top of it but of course we can't stay on top of everything. Does this mean you have access to the science community to say it lacks you know. Do you talk with these people who are very fortunate in that in this area. We are blessed with so many experts at all of the major teaching institutions so we can get on the phone and talk to them we can talk to people all over the world who are experts in their particular

arena. We can talk to people in the pharmaceutical industry we can look at the original research used to be we had to go to a medical library and now our computer gets us into the best medical library in the world. Who are the best listeners men or women. See what a great question you know I don't think it starts out by gender I think it really depends on the individual. But I'll tell you this women are far more concerned about their health and the health of their families. So far more often than it's a woman who is listening to our radio show Rudy reading our newspaper column and reading our books. That isn't to say men are concerned when they get diagnosed with prostate cancer or high blood pressure or rectal dysfunction. All of a sudden their interest goes up. You know but I think a lot of that is minimal or afraid of it good women. That could well be. Yeah. And I think they tend to be reactive. Wait till something happens whereas women are more proactive they want to prevent osteoporosis if they can

prevent it. They want to prevent a stroke by taking their medications or by getting you know their blood pressure under control through diet and exercise so I think women are more proactive and men are more reactive they wait till the bad news is delivered you to a before the graduating class at the medical school that's next to you. This book would lead you to say them two or three things that you must carry with you in your practice. What would you say the first thing I'd say and listen to your patients really pay attention. There is a frequent phrase that's given at a commencement address. Half of what we taught you was wrong. We just don't know which half. And I fear that that is still true today. I would also encourage medical students as they become physicians to have a strong dose of humility and recognize that mistakes do happen. They happen far more frequently than anyone would like to believe in fact based on the research that we did in this book that's based on the

medical literature. Health care harm is right up there with the leading killers in this country right up there with heart attacks and right up there with cancer. She was number three number three. So that means you have to work very hard to prevent harming your patients. Work with them as a partnership and reading behind you thought back to the times when people worked hard physically. But they were wrong. Now we don't exercise at all but we're learning to eat in terms of cholesterol and all these of things. How do you tell the audience that you and Terry appear before often. How do you get at them to begin to really appreciate what you're saying. Well we frequently point out to them that their grandmothers actually knew quite a lot about good health. Boy did they. And if they paid attention to grandmother's advice they could do well.

So what did grandma say. Grandma said first of all eat your vegetables and we now know that fruits and vegetables are really important and you eat a lot of them. She said get a good night's sleep. And she met eight hours of sleep a day don't stay up till midnight doing your e-mail she said. Exercise you know if you're under stress go out and chop some wood and we now know that exercise is essential for block to preventing depression for your heart for just about every aspect of your body preventing diabetes What else did she say Terry. Well I'm a grandma was a big fan of family get togethers and we now know that social support is an absolutely crucial element in our overall health. And then she said during the winter time in particular have some cod liver oil. She didn't know why but she knew that there were something about cod liver oil didn't taste very good but it had omega 3 fatty acids the fish oil and it had Vitamin D and we now know that vitamin D is essential in keeping your immune system strong to reduce your risk of flu and colds so Grandma had a lot of wisdom.

Now both of you talk to the teenager about it. They had their sensitive so get talked at so much but there's nothing more important in the personal tales. What do you say to young people. Well I think before actually just going in and telling young people this is what you need to do now we've got to find out what they're concerned about what they're interested in. And that's that's the best place to start with a young person because so often when we're young I remember when I was a teenager I then figure you know there was going to be anything wrong with me at least not for a long long time or ever. I think you know it's a perfect example of how we need to talk with people not at them. Right and I think too many adults like to shake their finger and tell teenagers what they shouldn't be doing and I think doctors have kind of gotten into that same attitude when it is you know just talking to their patients. It needs to really be collaborative. It needs to be a partnership we said that it is. Many times we can't say it enough. And that's the same kind of relationship with

teenagers. A lot of teens are interested in their health they're interested in their athletic ability they're interested in their skin for example they're interested in a lot of different aspects of health but they're not perhaps as receptive to being lectured. What's been the reception of what you've written. Well a lot of patients have shared their stories their own personal tragedies a dear friend goes into the hospital for a knee replacement. They're in perfect health and two weeks later they've died because of a C diff infection so they've shared those tragedies with us. I think the doctors initially are feeling a little bit sensitive about the title of the book but the doctors who are at the cutting edge of patient safety they're right on board and share our concerns and are part of the team. There is an gentleman here it is top screw up doctors and how to avoid them go down to the bookstore and get your copy and put it beside the bed. It's important for you to read this book and to learn the lessons of

all of this research that's brought forward. Joe and Terry thank you for sitting down with me one more time. It's been a joy. I've tried to listen and I'm sure this audience has so thank you for being here. Good night friends. We'll see you next week. Funding for North Carolina people is provided in part by Wells Fargo. When you want to bank with greater accessibility Wells Fargo is with you giving you the tools to help you stay connected. Wells Fargo together will go far. And through the financial contributions of viewers like you who invite you to join them in supporting you in CTV.